Resident Evaluation
Resident's Name					Rotation Name						Rotation Year
Attending Name					Rotation Month Select a month... January February March April May June July August September October November December						Evaluation Date
		Unsatisfactory			Satisfactory			Superior
1.	Patient Care Incomplete, inaccurate medical interviews, physical examinations, and review of other data; incompetent performance of essential procedures; fails to analyze clinical data and consider patient perferences when making medical decisions.	1	2	3	4	5	6	7	8	9	Superb, accurate, comprehensive medical interviews, physical examinations, review of other data, and procedural skills, always makes diagnostic and therapeutic decisions based on available evidence, sound judgment, and patient preferences.
2.	Medical Knowledge Limited knowledge of basic and clinical sciences; minimal interest in learning; does not understand complex relations, mechanisms of disease.	1	2	3	4	5	6	7	8	9	Exceptional knowledge of basic and clinical sciences; highly resourceful development of knowledge; comprehensive understanding of complex relationships, mechanisms of disease.
3.	Practice-Based Learning/Improvement Fails to perform self-evaluation; lacks insight, initiative; resists of ignores feedback; fails to use information technology to enhance patient care or pursue self-improvement.	1	2	3	4	5	6	7	8	9	Constantly evaluates own performance, incorporates feedback into improvement activities; effectively uses technology to manage information for patient care and self-improvement.
4.	Interpersonal and Communication Skills Does not establish even minimally effective therapeutic relationships with patients and families; does not demonstrate ability to build relationships through listening, narrative or nonverbal skills,; does not provide education or counseling to patients, families, or colleagues.	1	2	3	4	5	6	7	8	9	Establishes a highly effective therapeutic relationship with patients and families; demonstrates excellent relationship building through listening, narrative and nonverbal skills; excellent education and counseling of patients, families, and colleagues; always "interpersonally" engaged.
5.	Professionalism Lacks respect, compassion, integrity, honesty; disregards need for self-assessment; fails to acknowledge errors; does not consider needs of patients, families, colleagues; does not display responsible behavior.	1	2	3	4	5	6	7	8	9	Always demonstrates respect, compassion, integrity, honesty; teaches/role models responsible behavior; total commitment to self-assessment; willingly acknowledges errors; always considers needs of patients, families, and colleagues.
6.	System-Based Learning Unable to access/mobilize outside resources; actively resists efforts to improve systems of care; does not use systematic approaches to reduce error and improve patient care.	1	2	3	4	5	6	7	8	9	Effectively accesses/utilizes outside resources; effectively uses systematic approaches to reduce errors and improve patient care; enthusiastically assists in developing systems' improvement.
7.	Resident's Overall Clinical Competence in Internal Medicine on Rotation	1	2	3	4	5	6	7	8	9
8.	Comments:
9.	Was the evaluation reviewed with the resident?	Yes No
10.	Attending name