MCSO/OSU-CHS

GENERAL SURGERY

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
Intern/Resident has consistently consulted with you appropriately	1	2	3	4	5	UE
Intern/Resident recognizes and consistently uses the correct diagnostic tools and approach in the acute abdomen	1	2	3	4	5	UE
Intern/Resident shows competence in the pre-surgical stabilization or preparation of the surgical patient	1	2	3	4	5	UE
Intern/Resident shows competence in the postoperative management of the surgical patient	1	2	3	4	5	UE
Intern/Resident shows competence as a first assist in the surgical suite	1	2	3	4	5	UE
Intern/Resident shows competence in their ability to perform minor surgery such as I&D and packing of an abcess	1	2	3	4	5	UE
Intern/Resident shows competence in wound debridement	1	2	3	4	5	UE

ROTATION SPECIFIC COMMENTS

Comments * 🛈

Signature of Evaluator *

UPIN

SSN

MCSO ID MCSO ID

Date: *