MCSO/OSU-CHS
OB/GYN FOR RESIDENTS
NAME OF RESIDENT
Monica Woodall, DO
Michael Roach, DO
Andrew Hamill,DO
Robert Gispanski, DO
Mike Boger, DO
Thomas Jarvis, DO
Alex Roby DO
Clay Garrett DO
Robert Moody DO
Tim Newton DO
Rotation Dates
Month
Jan
Feb
March
April
May
June
July
August
Sept
Oct
Nov
Dec
Year
2010
2011
2012
2013
2014
2015
Name of evaluator
Dr. Cuesta
Dr. Lee
Dr. Surredi
Dr. Taylor
Dr. Whittington
other
Lichert Scale 1=poor 3=average 5=excellent
CORE COMPETENCY EVALUATION
Did the intern / resident demonstrate Osteopathic Skills during this rotation?
1
2
3
4
5
UE
Did the Intern demonstrate adequate medical knowledge during this rotation?
1
2
3
4
5
UE
Did the intern / resident demonstrate professionalism during this rotation?
1
2
3
4
5
UE
Did the Intern / Resident demonstrate adequate interpersonal and communication skills during this rotation?
1
2
3
4
5
UE
Did the Intern / Resident demonstrate adequate patient care skills for their level of training?
1
2
3
4
5
EU
Did the Intern demonstrate adequate use of resource materials during this rotation?
1
2
3
4
5
UE
Did the Intern / Resident demonstrate punctuality
1
2
3
4
5
UE
ROTATION SPECIFIC QUESTIONS
1
2
3
4
5
UE
Does the resident have a good grasp on the normal and abnormal PAP?
Can the resident perform colposcopy and understand indications for same?
Is the resident competent in birth control methods and products?
Does the resident show competence in the diagnosis and treatment of vaginitis, cervicitis, PID?
Can the resident co-ordinate the workup of a breast mass?
Is the resident competent to work up a pelvic mass?
Is the resident competent to drain a cystic breast lesion?
Does the resident show adequate knowledge to treat or prevent osteoporosis?
Is the resident comfortable in the arena of HRT?
Rotation Specific Questions
1
2
3
4
5
UE
The resident has become competent to deliver the uncomplicated pregnancy
The resident is competent to refer the complicated pregnancy
The resident is competent to do adequate pre-partum care
The resident is competent to do satisfactory post-partum care
The resident has become competent in all stages of labor and delivery
Please estimate the number of c-sections attended by the resident
Please estimate the number of deliveries attended by the resident during the rotation
ROTATION SPECIFIC COMMENTS
Comments
Signature of Evaluator
UPIN
SSN
MCSO ID
Date:
Indicates Response Required