Cincinnati VAMCResident Evaluation

Date:______

Name of Resident:______

Select one of the following responses for each statement listed below:

  1. Not acceptable
  2. Below expected performance (for current month of residency)
  3. Meets expected performance (for current month of residency)
  4. Exceeds expected performance (for current month of residency)
  5. Exceptional

Technical Skills 1 2 3 4 5

  1. Is able to perform tests and procedures

accurately and reliably______

  1. Understands the purpose/value of tests and

the indications for ancillary tests and procedures______

  1. Willingly and independently works to gain

proficiency with a variety of techniques and

instruments______

Organizational Skills 1 2 3 4 5

  1. Utilizes a clear, logical and methodical

examination sequence______

  1. Gathers an orderly, problem-oriented case

history and clearly defines the reason for

presentation and/or chief complaint______

  1. Analyzes clinical data in a logical, sequential

manner______

  1. Develops orderly, legible clinical records

and documents______

  1. Documents findings accurately and completely

using precise, appropriate terminology______

  1. Completes examinations and procedures in

an appropriate amount of time______

  1. Consistently completes necessary paperwork

in a timely manner______

Diagnosis and Assessment Skills 1 2 3 4 5

  1. Logically analyzes data and makes diagnoses

consistent with clinical data______

  1. Demonstrates appropriate knowledge of

differential diagnosis______

  1. Displays flexibility in problem solving and is

willing to consider new strategies and
approaches______

  1. Diagnosis involves independent and appropriate

use of reference materials______

Management and Treatment Skills 1 2 3 4 5

  1. Possesses knowledge base necessary to develop

appropriate management and treatment plan______

  1. Plan is developed logically and with appropriate

faculty consultation______

  1. Plan developed is complete, appropriate for

assessment and diagnosis, and addresses all

active problems______

  1. Can prioritize among various management

options, taking into account individual patient

circumstances and social factors ______

  1. Management plans and treatments are formulated

through the independent use of appropriate

resources and references______

  1. Remains open to new management options

and concepts______

Communication Skills 1 2 3 4 5

  1. Effectively communicates with patients demonstrating

confidence, enthusiasm, and professionalism with

even the most challenging patients______

  1. Demonstrates good case presentation skills;

effectively presenting significant aspects of case

history, clinical findings, assessment and

management plan.______

  1. Effectively communicates findings/plan to

patient in a manner that maximizes patient

understanding and compliance______

  1. Establishes and maintains open communication

and good rapport with faculty ______

  1. Provides constructive feedback regarding the

supervising faculty and clinical programs______

Attitude and Work Habits 1 2 3 4 5

  1. Accepts constructive criticism in a mature manner______
  1. Is able to adapt to established clinic protocol______
  1. Demonstrates a sophisticated ability to honestly

assess own strengths and weaknesses______

  1. Displays empathy and respect for patients______
  1. Is conscientious in follow-up of patients and

demonstrates interest in their progress______

  1. Demonstrates, by his/her actions, a desire to

maximize both the quantity and diversity of

patient encounters______

  1. Displays genuine enthusiasm for patient care

and optometry______

  1. Enthusiastically and independently seeks out

new knowledge______

  1. Willingly helps out others in the clinic without

prompting and contributes to smooth, efficient

operation of the clinic______

Academic Activities 1 2 3 4 5

  1. Regularly consults textbooks and periodicals in

formulating diagnostic, management, and

treatment plans on patients______

  1. Presentations are well researched, with a

thorough literature review______

  1. Presents lectures in a clear, organized

manner with effective oral delivery______

  1. Displays proficiency in the critical analysis,

evaluation, and interpretation of scientific literature______

  1. Regularly attends Grand Rounds, meetings, and

clinical conferences______

  1. Demonstrates an acceptable level of progress

on research topic or paper______

Signature of Resident:______

(date)

Signature of Attending: ______

(date)

Please feel free to write on the back of this page any additional comments, suggestions, etc. which you feel would be helpful feedback.

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