Report of Annual Evaluation Compentency Analysis

 HARLEM HOSPITAL CENTER

DEPARTMENT OF SURGERY

COMMITTEE ON RESIDENT SELECTION AND EVALUATION

 

REPORT OF ANNUAL EVALUATION

COMPENTENCY ANALYSIS

 

NAME:                                                                           ACADEMIC YEAR: 

STARTING DATE:                                                       FUNCATIONAL PGY LEVEL:  

 

RATING SCALE:  1-9   (1-3 Unsatisfactory, 4-6 Satisfactory, 7-9 Superior)

Patient Care
Staff Members Evaluation
 

 

Surgical Knowledge      Structured Case Discussion/Presentation  
Practice-Based Learning   Resident Operating Room Encounter  
Interpersonal and Communication Skills   Conscientiousness/Initiative/Effort  
Professionalism   Leadership Skills  
System-Based Learning         Oral Examination  
Chart Documentation
 
 

 

Internal Examination
 
 

 

Comments:

                                             

APPROVED:  ______________________                                 __________________

                         Program Director                                                 Director of Surgery


I have read this evaluation:                                             

 

                                                                                                                        

______________________                                                                            

House Staff Signature

House Staff Comments:_____________________________________________________________