Final Evaluation Form: CFPC-EM Program
October 30, 2000
Name
Year
Director
Anesthesia
Inadequate (1-2) well-balanced(3) excessive(4-5)
12345N/A
Workload during shifts
Schedule
Clinical teaching
Procedures
Time for self-learning
Degree of Supervision
Degree of Autonomy
Accolades to:
Comments:
St. Boniface Emergency
Inadequate (1-2) well-balanced(3) excessive(4-5)
12345N/A
Workload during shifts
Schedule
Clinical teaching
Procedures
Time for self-learning
Degree of Supervision
Degree of Autonomy
Accolades to:
Comments:
Pediatric Emergency
Inadequate (1-2) well-balanced(3) excessive(4-5)
12345N/A
Workload during shifts
Schedule
Clinical teaching
Procedures
Time for self-learning
Degree of Supervision
Degree of Autonomy
Accolades to:
Comments:
HSC Emergency
Inadequate (1-2) well-balanced(3) excessive(4-5)
12345N/A
Workload during shifts
Schedule
Clinical teaching
Procedures
Time for self-learning
Degree of Supervision
Degree of Autonomy
Accolades to:
Comments:
Trauma Surgery
Inadequate (1-2) well-balanced(3) excessive(4-5)
12345N/A
Workload during shifts
Schedule
Clinical teaching
Procedures
Time for self-learning
Degree of Supervision
Degree of Autonomy
Accolades to:
Comments:
MICU
Inadequate (1-2) well-balanced(3) excessive(4-5)
12345N/A
Workload during shifts
Schedule
Clinical teaching
Procedures
Time for self-learning
Degree of Supervision
Degree of Autonomy
Accolades to:
Comments:
SICU
Inadequate (1-2) well-balanced(3) excessive(4-5)
12345N/A
Workload during shifts
Schedule
Clinical teaching
Procedures
Time for self-learning
Degree of Supervision
Degree of Autonomy
Accolades to:
Comments:
Selective (specify______)
Inadequate (1-2) well-balanced(3) excessive(4-5)
12345N/A
Workload during shifts
Schedule
Clinical teaching
Procedures
Time for self-learning
Degree of Supervision
Degree of Autonomy
Accolades to:
Comments:
Selective (specify______)
Inadequate (1-2) well-balanced(3) excessive(4-5)
12345N/A
Workload during shifts
Schedule
Clinical teaching
Procedures
Time for self-learning
Degree of Supervision
Degree of Autonomy
Accolades to:
Comments:
Research Project
Inadequate (1-2) well-balanced(3) excessive(4-5)
12345N/A
Workload
Preparation time
Access to Resources
Degree of Supervision
Feedback after Presentation
Disagree(1-2) Neutral(3) Agree(4-5)
12345N/A
Was useful
Taught Critical Appraisal skills
Encouraged further research
Accolades to:
Comments:
Academic Halfday
Inadequate (1-2) well-balanced(3) excessive(4-5)
12345N/A
Workload
Preparation time
Access to Resources
Degree of Supervision
Organization
Accolades to:
Comments:
Other:
Please comment on the strengths and/or weaknesses of the following:
Director-Resident meetings:
Lifeflight:
Sexual Assault Protocol Experience:
Elective:
(How did you use your elective time?)
Please submit this final evaluation form to the Emergency Medicine Office at A1119, SBGH, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Attention: Administrative Assistant.
Revised June 2007
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