ROTATION: LOCATION: ROTATION
DIRECTOR:
RESIDENT: Month/Year:
KEY 5 = OUTSTANDING 4 = VERY GOOD 3 =
ACCEPTABLE 2 = NEEDS IMPROVEMENT
1 = UNSATISFACTORY N =
NOT OBSERVED OR NOT APPLICABLE
Please Circle the Applicable Response
that Describes your Experience on this Rotation:
PATIENT CARE
1. 5 4 3 2 1 N Appropriate
patients for teaching purposes
2. 5 4 3 2 1 N Contact time with patients
3. 5 4 3 2 1 N Control of your patient care
4. 5 4 3 2 1 N Appropriate level of supervision by faculty
MEDICAL
KNOWLEDGE
5. 5 4 3 2 1 N Availability
of didactics and teaching conferences
6. 5 4 3 2 1 N Ability to learn procedures or skills
specific to this rotation
7. 5 4 3 2 1 N Quality of teaching from faculty and/or
upper level residents
PROFESSIONALISM
8. 5 4 3 2 1 N General
attitude of people in setting toward you (faculty, residents, staff)
9. 5 4 3 2 1 N Attitude
of people in setting toward Family Medicine, in general
10. 5 4 3 2 1 N Rotation’s compliance with work hour rules
11. 5 4 3 2 1 N Availability of nursing or ancillary staff
PRACTICE-BASED
LEARNING AND IMPROVEMENT
12. 5 4 3 2 1 N Integration of evidence-based medicine into
teaching and practice
13. 5 4 3 2 1 N Availability of reading time
INTERPERSONAL
AND COMMUNICATION SKILLS
14. 5 4 3 2 1 N Values effective therapeutic relationships
with patients and families
15. 5 4 3 2 1 N Values education and counseling of patients
and families
SYSTEM-BASED
PRACTICE
16. 5 4 3 2 1 N Models cost sensitive and cost efficient
care (e.g., use of tests, choice of meds)
17. 5 4 3 2 1 N Assists
the patient in dealing with health care system complexities
GENERAL
ATTRIBUTES
18. 5 4 3 2 1 N Clarification of role expectations by the
Rotation Director
19. 5 4 3 2 1 N Fringe benefits (call room, meal tickets,
etc.)
20. 5 4 3 2 1 N Rotation utilization of your time
21. 5 4 3 2 1 N Attainment of expected competencies
22. 5 4 3 2 1 N General rating that you would give this
rotation
DUTY HOURS
23. T F My average
clinical workweek over a month does not exceed an average of 80 hours per
week at the hospital/clinic.
24. T
F My continuous on-site duty, including
in-house call, does not exceed 24 consecutive hours with an
additional 6 hours
(total consecutive 30 hours) included for me to participate in educational
activities, maintain continuity of
medical/surgical care, transfer care or conduct out-patient
continuity clinics
25. T
F My assigned schedule gives me an average of 1 day out
of 7 days free from all clinical
responsibilities each month. (“One day” is defined as
one continuous 24-hour period free of all
clinical, educational
and administrative activities).
List the 3 best aspects of this rotation?
_________________________________________________________________
__________________________________________________________________________________________
List 3 things that should be improved about the
rotation? __________________________________________________
__________________________________________________________________________________________
Other comments:
__________________________________________________________________________________
__________________________________________________________________________________________
Please
return to Stacey Riddling, Residency Coordinator, DFPM, UAMS, Slot 530
Revised: 9/15/06