YaleNew HavenHospital
Surgical Critical Care Fellow Evaluation Form
Fellow:
Year of TrainingPGY-6
Hospital/ Training Site YNHH Bridgeport
Rotation Dates
On-service with fellow
Interaction on-call only
No significant interaction with fellow
Evaluation Scale
5- Far exceeds reasonable expectations; clearly outstanding. Only a few will merit this rating
4- Exceeds reasonable expectations in virtually all areas
3- Always meets reasonable expectations and occasionally exceed them. Most merit this rating
2- In general, meets reasonable expectations but occasionally falls short.
1- Often falls short of reasonable expectations; cause for real concern. Performance unsatisfactory.
CIRCLE OR UNDERLINE ONE
Patient Care:Fellow provides patient care that is compassionate, appropriate and effective.
Gathers accurate, essential information
from all sources.12345
Demonstrates skill in procedures.12345
Develops and implements effective patient
management plans and integrates plans
into patient care. 12345
Demonstrates appropriate ventilator
management, including pressure and
volume cycled ventilators, CPAP, and
oxygen delivery systems. 12345
Assumes a leadership role in orchestrating
patient care. 12345
Demonstrates appropriate operative and
nonoperative decision making skills12345
______
OverallPatient Care Evaluation12345
Medical Knowledge: Fellow demonstrates knowledge of established and evolving clinical science and the application of said knowledge to patient care and education.
Open-minded to acquiring new
knowledge. 12345
Develops clinically applicable knowledge
of the basic and clinical science that
underlies the practice of critical care. 12345
Accesses and critically evaluates scientific
evidence.12345
Applies knowledge to clinical problem
solving, decision-making and critical thinking.12345
______
Overall Medical Knowledge Evaluation12345
Communication Skills: Fellow demonstrates effective information exchange and collaboration with patients, their families and other healthcare providers.
Communicates effectively with other
physicians and health care providers. 12345
Communicates effectively with patients. 12345
Communicates effectively with families. 12345
Maintains timely, legible, accurate medical records12345
______
Overall Communications Skills Evaluation12345
Professionalism: Fellow demonstrates behaviors that reflect a commitment to continuous professional development, ethical practice, and a responsibility towards patients and society.
Demonstrates respect, compassion, integrity 12345
and altruism.
Demonstrates sensitivity to gender, age,
culture, religion, socioeconomic status, beliefs
and behaviors of patients and colleagues. 12345
Adheres to the principles of confidentiality,
integrity and informed consent. 12345
Overall Professionalism Evaluation12345
Practice Based and Lifelong Learning:
Evidence-based knowledge12345
Learns from mistakes12345
Understands areas of controversy12345
Accepts constructive criticism12345
Develop and maintain a willingness to learn
from errors, and to use errors to critically
evaluate the system or process of care. 12345
Use information technology to access and
manage information, support patient care and
enhance education.12345
Critically evaluate the literature and devise
evidence based practice guidelines.12345
Overall Practice Based Learning Evaluation12345
System Based Practice: Fellow will demonstrate an understanding of the context and system of healthcare.
Utilize resources necessary to provide
optimal patient care.12345
Apply evidence-based strategies of prevention,
diagnosis and disease management. 12345
Overall System Based Practice Evaluation 12345
Composite Evaluation12345
Comments:
Signature:Printed Name:
Date completed: ______/______/ 20______
1
Revised: 8/4/2009