MCSO/OSU-CHS

NEWBORN NURSERY

NAME OF RESIDENT *

Rotation Dates

Month *

Year *

Name of Evaluator
Dr. Akin
Dr. Simulescu
Dr. Varughese *

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
Evaluates newborns well	1	2	3	4	5	UE
Evaluation of at risk or sick newborns	1	2	3	4	5	UE
APGAR scoring accuracy	1	2	3	4	5	UE
Newborn IV therapy ability	1	2	3	4	5	UE
Stabilization of the newborn	1	2	3	4	5	UE
ABG sampling ability	1	2	3	4	5	UE
Dubowitz scale	1	2	3	4	5	UE
O2 therapy in the newborn	1	2	3	4	5	UE
Circumcision ability	1	2	3	4	5	UE
Basic newborn lab and interpretation	1	2	3	4	5	UE
Jaundice/Phototherapy	1	2	3	4	5	UE
Newborn Intubation	1	2	3	4	5	UE
Bag and Mask ventilation ability	1	2	3	4	5	UE
Algo hearing screening	1	2	3	4	5	UE

ROTATION SPECIFIC COMMENTS

Comments * 🛈

Signature of Evaluator *

UPIN

SSN

MCSO ID MCSO ID

Date: *