Annual Program Evaluation
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1
2
3ANNUAL PROGRAM EVALUATION
Academic Year ending June 30, 20
Program:
Name
e-mail address
Phone
number
Program Director
Program Coordinator
Division/Department Chair
Trainees:
Training Year
1
ACGME Approved number:
Actual number of trainees:
Total Number this
Maximum Number at
Other learners:
Academic Year
any time
Residents from other programs
Medical Students
Subspecialty Fellows
Do you have
Yes
No
A written supervision policy for each activity and level of training?
A written trainee selection policy?
Documentation of prior training for each trainee?
If no, please explain:
PROGRAM CHANGES
.
Describe any changes that have occurred to the program during the past year
RESIDENT/FELLOW PERFORMANCE
Documented Evaluations
used:
Faculty
Peers
Nursing
Medical Students
Social Worker
Residents from Outside Program
Patient
Fellows
Self
Other(specify)
Other(specify)
Other(specify)
Other Evaluation Methods Used:
In-Service Exam
Portfolio
Formal Oral Exam
Record Review
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Parent category: Business