MCSO/OSU-CHS

NIGHTS

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
Responds to emergencies appropriately/Triages well	1	2	3	4	5	UE
Competent in wound repair/revision	1	2	3	4	5	UE
More adept at a directed H&P and differential diagnosis	1	2	3	4	5	UE
More competent at formulating a cost -effective care plan	1	2	3	4	5	UE
Competent to run a code	1	2	3	4	5	UE
Placement of central lines	1	2	3	4	5	UE
Placement of ET tubes	1	2	3	4	5	UE
ABG draw,interpretation and tx of patient	1	2	3	4	5	UE
Uses basic lab results appropriately	1	2	3	4	5	UE
Xray diagnoses,eg.CHF/Pneumonia,Fractures are accurate	1	2	3	4	5	UE
Reduction of dislocations	1	2	3	4	5	UE
Splints and Casts	1	2	3	4	5	UE
Dispenses Appropriate Meds	1	2	3	4	5	UE
Gives Appropriate Advice to Patients	1	2	3	4	5	UE
Rational patient followup directions	1	2	3	4	5	UE
Documentation skills have progressed	1	2	3	4	5	UE

ROTATION SPECIFIC COMMENTS

Comments * 🛈

Signature of Evaluator *

UPIN

SSN

MCSO ID MCSO ID

Date: *