MCSO/OSU-CHS

ENT

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 demonstrated 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
Does the Intern/Resident recognize pathology that needs to be referred?	1	2	3	4	5	UE
Has the Intern/Resident referred to you inappropriately or appropriately?	1	2	3	4	5	UE
Is the Intern/Resident competent to treat OM,OE,?	1	2	3	4	5	UE
Can the Intern/Resident recognize and treat various presentations of sinusitis?	1	2	3	4	5	UE
Can the Intern/Resident treat epistaxis competently?	1	2	3	4	5	UE
Can the Intern/Resident deal competently with cerumen impactions?	1	2	3	4	5	UE
Can the Intern/Resident recognize and treat foreign bodies of the ear or nose?	1	2	3	4	5	UE
Can the Intern/Resident recognize and treat allergic and non-allergic rhinitis?	1	2	3	4	5	UE
Does the Intern/Resident understand the evaluation for hoarseness?	1	2	3	4	5	UE
Has the Intern/Resident recognized and evaluated hearing disorders correctly?	1	2	3	4	5	UE
Does the Intern/Resident diagnose and deal with nasal polyps correctly?	1	2	3	4	5	UE
Does the Intern/Resident have a good basic understanding of tinnitus and dizziness?	1	2	3	4	5	UE
Can the Intern/Resident recognize and deal with basic salivary gland disorders?	1	2	3	4	5	UE

ROTATION SPECIFIC COMMENTS

Comments * 🛈

Signature of Evaluator *

UPIN

SSN

MCSO ID MCSO ID

Date: *