MCSO/OSU-CHS

Ophthalmology

NAME OF RESIDENT *

Rotation Dates

Month *

Year *

Name of Evaluator *

Lichert Scale 1=poor 3=average 5=excellent

CORE COMPETENCY EVALUATION

Did the intern / resident demonstrate Osteopathic Skills during this rotation? *

Did the Intern demonstrate adequate medical knowledge during this rotation? *

Did the intern / resident demonstrate professionalism during this rotation? *

Did the Intern / Resident demonstrate adequate interpersonal and communication skills during this rotation? *

Did the Intern / Resident demonstrate adequate patient care skills for their level of training? *

Did the Intern demonstrate adequate use of resource materials during this rotation? *

Did the Intern / Resident demonstrate punctuality *

ROTATION SPECIFIC QUESTIONS *

	1	2	3	4	5	UE
Can the intern/resident diagnose and manage the red eye?	1	2	3	4	5	UE
Is the intern/resident competent with the ophthalmoscope?	1	2	3	4	5	UE
Can the intern/resident identify cataracts?	1	2	3	4	5	UE
Is the intern/resident competent to suspect/diagnose diseases of the eye that merit referral?	1	2	3	4	5	UE
Can the intern/resident remove a simple foreign body from the cornea or sclera?	1	2	3	4	5	UE
Can the intern/resident manage a stye or chalazion?	1	2	3	4	5	UE
Is the concept of visual fields understood by the intern/resident?	1	2	3	4	5	UE
Can the intern/resident recognize and deal with strabismus?	1	2	3	4	5	UE
Does the intern/resident recognize glaucoma?	1	2	3	4	5	UE
Can the intern/resident measure intraocular pressure?	1	2	3	4	5	UE

ROTATION SPECIFIC COMMENTS

Comments * 🛈

Signature of Evaluator *

UPIN

SSN

MCSO ID MCSO ID

Date: *