Family Medicine Teaching Service Evaluation

Rotation Dates

Lichert Scale 1=poor 3=average 5=excellent

Did the intern / resident demonstrate Osteopathic Skills during this rotation? Did he/she apply OMT in the hospital and the continuity clinic setting? Was it appropriate? Did they apply osteopathic principles into their patient care activities? *
Did the Intern demonstrate adequate medical knowledge during this rotation? Did he/she show current knowledge? Was he/she current with new developments? Did the resident apply principles of clinical and behavioral medicine appropriately? *
Did the intern / resident demonstrate professionalism during this rotation? Did he/she show respect for families? Were they patient advocates? Were they honest with patients? Did they treat patients with compassion? Did they show an ethical concern for their patients? Did they show proper attention to issues of culture, age, gender, sexual orientation, mental and/or physical disabilities? Were they punctual? Were they properly attired? *
Did the Intern / Resident demonstrate adequate interpersonal and communication skills during this rotation? Did they show effectiveness in developing appropriate doctor-patient relationships? Did they demonstrate good listening skills? Did they demonstrate adequate written and oral communication skills in professional interactions with patients, families and other health care professionals? *
Did the Intern / Resident demonstrate adequate patient care skills for their level of training? Did they incorporate Osteopathic principles, patient empathy, good diagnostic and therapeutic plans? Did they show knowledge of preventative medicine measures? *
Did the Intern/Resident demonstrate adequate practice based learning and improvement skills? Did they integrate evidence based medicine into patient care? Did they show an understanding of research methods?
Can they apply outcomes based research? Did they use library resources to discover pertinent medical information?  *


Performs an adequate structural exam of patients *
Non procedural Goals and Objectives *
Specific Procedural Competencies *
Resident can perform a lumbar puncture
Resident can perform a thoracentesis
Resident can perform a paracentesis
Skin biopsy
Excision of lesions
Laceration repair
Joint injections, specific
EKG interpretation
Spirometry or PFTs
Urinary catheters
Endotracheal intubation
Central Line placement
Flexible sigmoidoscopy
Charts *
Charting is concise and complete
Charting clearly shows the level of care given to the patient
Charting is legible
Charts are presented to the supervising physician in a timely fashion
Overall Evaluation  *
Unsatisfactory -------------Outstanding
Signature of Evaluator  *
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