MOREHOUSE SCHOOL OF MEDICINE

EVALUATION FORM OF
PUBLIC HEALTH & PREVENTATIVE MEDICINE
RESIDENTS BY THE ROTATION COORDINATOR

CLINICAL PREVENTIVE MEDICINE


This form is recommended for use in the evaluation of residents seen on any of the basic
rotations in the Public Health and Preventive Medicine Residency Training Program. We
encourage preceptors to add written comments that would be helpful in determining
the resident's understanding of your particular compenent area.

If written reports were required as part of this rotation, please attached copies with your evaluation and/or comments of each report. Indicate the date the paper was reviewed with the resident and the final disposition of the project. 


1.   Complete the form on this web page.
2.   Print the form (for signatures), before you click Submit.
3.   Click Submit.

Resident's Name:

Rotation: 
Evaluator's Name: Dates:

Evaluate the resident's ability to carry out assigned tasks and provide substantive
comments for each assessment. Site the major strengths and weaknesses observed.
Global adjectives or remarks may not help distinguish a resident's performance.

Check the rating which best describes the residents's skills and abilities for each area of
competence. If you feel that a particular skill may need additional attention, please check
the appropriate box.


KEY:
1 = Poor-Needs Improvement   2 = Fair    3 = Good    4 =Excellent    0 = Did Not Observe  

COMMENTARY

JUDGEMENT

1

2

3

4

0

A. Is able to interpret relevant information and its medical significance; evaluate alternatives; and consider risks and benefits.

B. Understands limitations of his/her knowledge and skills.

C. Is able to establish priorities.

 

KNOWLEDGE OF CLINICAL PREVENTIVE MEDICINE

1

2

3

4

0

Evaluate individual, community-based, and population-based interventions to modify or elimate risks for disease and promote wellness.

Develop and refine screening programs for groups and individuals to identify risks for disease or injury, and opportunities to promote wellness.

Diagnose and manage disease/injuries/conditions of significance within public health/general preventive medicine.

Implement screening programs for groups and individuals.
 

HUMANISTIC QUALITIES

1

2

3

4

0

Demonstrates integrity, respect, compassion, and empathy for staff and peers.

Establishes trust.

Shows primary concern for the welfare of the community and opportunitis to promote wellness.
 

4. UTILIZATION OF COMPUTERS, STATISTICAL PACKAGES, RESOURCE MATERIALS

PERSONAL QUALITIES

1

2

3

4

0

A. Demonstrate confidence in own abilities

B. Is aware of own limits.

C. Able to cope with personal or professional problems.

D. Able to make appropriate decisions promptly based on risks.

E. Demonstrates personal honesty.

F. Maintains the confidentiality of medical information

G. Performs well under stress.

H. Demonstrates sensitivity and tolerance.

I. Is able to establish excellent rapport with community members, individual patients and staff.

J. Reports are legible and timely.
 

Successfully satisfied all sub-objectives for this rotation.

Overall level of competence in component area.
 

Remember to Print this form before you Submit.