MCSO/OSU-CHS

Sports Medicine

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/Resident 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
Recognizes sports injuries	1	2	3	4	5	UE
Evaluates sports injuries well	1	2	3	4	5	UE
Understands tenets of treatment	1	2	3	4	5	UE
Understands tenets of rehab	1	2	3	4	5	UE
Understands taping and splinting	1	2	3	4	5	UE
Performs the basic sports physical	1	2	3	4	5	UE
Knowledge concerning returning an athete to competition	1	2	3	4	5	UE
Specific evaluation of the shoulder	1	2	3	4	5	UE
Specific evaluation of the knee	1	2	3	4	5	UE
Specific evaluation of the ankle	1	2	3	4	5	UE
Evaluation of concussions--all grades	1	2	3	4	5	UE

ROTATION SPECIFIC COMMENTS

Comments * 🛈

Signature of Evaluator *

UPIN

SSN

MCSO ID MCSO ID

Date: *