360 Evaluation Medical Staff (Page 2 of 2) in pdf

360 Evaluation Medical Staff Page 2

360

EVALUATION

RESIDENT:

PGY:

EVALUATORS:

Date:

INTERPERSONAL and

Unsatisfactory Marginal Satisfactory

Good Excellent

Unknown

COMMUNICATION SKILLS

[ ]

Considerations: Communicates pertinent information clearly and in a timely fashion? Demonstrates ability to maintain confidential

information appropriately? Chooses words wisely and professionally? Listens first; considers the question and formulates answer?

Shows regard for opinions that differ from his/her own? Does not patronize or demonstrate inappropriate body language?

Comments:

Unsatisfactory Marginal Satisfactory

Good Excellent

Unknown

PRACTICE BASED LEARNING

[ ]

and IMPROVEMENT

Considerations: Can analyze own practice experience and patient population data to perform practice-based improvement

activities? Demonstrates ability to locate, critically appraise and assimilate evidence from scientific studies and apply to own

patients' health problems? Exhibits competence with information technology and accessing on-line medical resources to self-

educate and to guide patient education? Facilitates learning of students, colleagues and other health care team members?

Comments:

Unsatisfactory Marginal Satisfactory

Good Excellent

Unknown

SYSTEMS BASED PRACTICE

[ ]

Considerations: Exhibits understanding of types of medical practice, delivery systems & how his/her practices affect & are

impacted by other health care professionals, organizations & society? Practices cost-effective health care & resource allocation

while advocating for quality? Demonstrates understanding and can assist/inform others about system complexities? Works with

health care managers & providers to assess, coordinate and improve health care and system performance?

Comments:

SIGNATURE____________________________________________________

THANK YOU!

YOUR INPUT IS CRITICAL TO EACH RESIDENT'S SUCCESS.

360 Evaluation Medical Staff Page 2