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MCSO/OSU-CHS
Family Medicine Teaching Service Evaluation
NAME OF RESIDENT
*
Justin Mitchell, DO
Lauren Mitchell, DO
Jacinda (Jaci) Nuttle, DO
Sara Oldham, DO
Ana Crew, DO
Brian Lee, DO
Ashley Lomax-Walker, DO
Luke Records, DO
Justin Walker, DO
Kasey Welch, DO
Rotation Dates
Month
*
Jan
Feb
March
April
May
June
July
August
Sept
Oct
Nov
Dec
Year
*
2010
2011
2012
2013
2014
2015
Name of evaluator
*
Dr. Dillow
Dr. Gastorf
Dr. Gordon
Dr. Harrison
Dr. Jaiswal
Dr. Mike Lee
Dr. Terry Lee
Dr. Shaffer
Dr. Jestis
Other
Lichert Scale 1=poor 3=average 5=excellent
CORE COMPETENCY EVALUATION
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?
*
1
2
3
4
5
UE
Comments
*
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?
*
1
2
3
4
5
UE
Comments
*
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?
*
1
2
3
4
5
UE
Comments
*
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?
*
1
2
3
4
5
UE
Comments
*
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?
*
1
2
3
4
5
EU
Comments
*
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?
*
1
2
3
4
5
UE
Comments
*
ROTATION SPECIFIC ITEMS
Number of Hospital OMT cases logged
*
Number of clinic OMT cases logged
*
Performs an adequate structural exam of patients
*
1
2
3
4
5
UE
Non procedural Goals and Objectives
*
Able to assume significant patient care responsibilites
Participate and direct the team process
Assumes the role of trainer with students
Has developed skills in effective utilization of available services
Has developed skills in patient evaluation
Has developed skills in treatment planning
Specific Procedural Competencies
*
1
2
3
4
5
UE
Resident can perform a lumbar puncture
1
2
3
4
5
UE
Resident can perform a thoracentesis
1
2
3
4
5
UE
Resident can perform a paracentesis
1
2
3
4
5
UE
I&D
1
2
3
4
5
UE
Skin biopsy
1
2
3
4
5
UE
Excision of lesions
1
2
3
4
5
UE
Cryo
1
2
3
4
5
UE
Curettage
1
2
3
4
5
UE
Laceration repair
1
2
3
4
5
UE
Joint injections, specific
1
2
3
4
5
UE
Casting
1
2
3
4
5
UE
EKG interpretation
1
2
3
4
5
UE
Spirometry or PFTs
1
2
3
4
5
UE
Defibrillation
1
2
3
4
5
UE
Urinary catheters
1
2
3
4
5
UE
Endotracheal intubation
1
2
3
4
5
UE
Central Line placement
1
2
3
4
5
UE
Flexible sigmoidoscopy
1
2
3
4
5
UE
Colonoscopy
1
2
3
4
5
UE
Charts
*
1
2
3
4
5
UE
Charting is concise and complete
1
2
3
4
5
UE
Charting clearly shows the level of care given to the patient
1
2
3
4
5
UE
Charting is legible
1
2
3
4
5
UE
Charts are presented to the supervising physician in a timely fashion
1
2
3
4
5
UE
Overall Evaluation
*
1
2
3
4
5
UE
Unsatisfactory -------------Outstanding
1
2
3
4
5
UE
Comments
*
🛈
Signature of Evaluator
*
UPIN
SSN
MCSO ID
MCSO ID
Date:
*
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