MCSO/OSU-CHS
NIGHTS
NAME OF RESIDENT
Mike Boger, 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
involved physician
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/Resident 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
Responds to emergencies appropriately/Triages well
Competent in wound repair/revision
More adept at a directed H&P and differential diagnosis
More competent at formulating a cost -effective care plan
Competent to run a code
Placement of central lines
Placement of ET tubes
ABG draw,interpretation and tx of patient
Uses basic lab results appropriately
Xray diagnoses,eg.CHF/Pneumonia,Fractures are accurate
Reduction of dislocations
Splints and Casts
Dispenses Appropriate Meds
Gives Appropriate Advice to Patients
Rational patient followup directions
Documentation skills have progressed
ROTATION SPECIFIC COMMENTS
Comments
Signature of Evaluator
UPIN
SSN
MCSO ID
Date:
Indicates Response Required