MCSO/OSU-CHS

Wound Care

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
Understands the indications for HBOT	1	2	3	4	5	UE
Understands the contraindications and risks for HBOT	1	2	3	4	5	UE
Understands the indications for debridement	1	2	3	4	5	UE
Shows the ability to adequately debride a wound	1	2	3	4	5	UE
Shows the ability and versatility to dress a wound, perform a dressing change, to order proper materials to used on or in the wound	1	2	3	4	5	UE
Understands appropriate indications for an I&D	1	2	3	4	5	UE
Performs an I&D satisfactorily	1	2	3	4	5	UE

ROTATION SPECIFIC COMMENTS

Comments * 🛈

Signature of Evaluator *

UPIN

SSN

MCSO ID MCSO ID

Date: *