MCSO/OSU-CHS

INTERNAL 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 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
Did the Intern/Resident show a good command of admission criteria?	1	2	3	4	5	UE
Did the Intern/Resident show a good command of discharge criteria?	1	2	3	4	5	UE
Does the Intern/Resident show a basic understanding of imaging studies?	1	2	3	4	5	UE
Does the Intern/Resident demonstrate the ability to work with specialists?	1	2	3	4	5	UE
Does the Intern/Resident show understanding of monitoring equipment?	1	2	3	4	5	UE
Is the Intern/Resident showing good judgement in patient management?	1	2	3	4	5	UE
Is the Intern/Resident progressing with regard to appropriate procedures?	1	2	3	4	5	UE

ROTATION SPECIFIC COMMENTS

Comments * 🛈

Signature of Evaluator *

UPIN

SSN

MCSO ID MCSO ID

Date: *