Wright Consultation eval form R1
Wright Consultation eval form R1
Wright Consultation eval form R1
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<strong>R1</strong> COMPETENCY BASED<br />
CONSULTATION EVALUATION FORM<br />
Resident: ___________________________ Site: ______________________________<br />
Evaluator: ______________________<br />
Evaluation Period May to October Nov to April (circle one)<br />
Specific written comments by competency or in summary are requested. Comments must be<br />
included if "needs improvement" is selected for any item.<br />
1. Patient Care<br />
Milestone<br />
Identifier<br />
PC-A1<br />
PC-B1<br />
PC-B2<br />
PC-C1<br />
PC-C2<br />
PC-E1<br />
PC-F1<br />
PC-F2<br />
Milestone<br />
Acquire accurate and relevant history from the patient in an efficiently<br />
customized, prioritized, and hypothesis driven fashion<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Per<strong>form</strong> an acute physical exam that is appropriately targeted to the<br />
patient’s complaints and medical conditions. Identify pertinent<br />
abnormalities using common maneuvers.<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Accurately track important changes in the physical exam over time in the<br />
inpatient settings.<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Synthesize all available data, including interview, physical exam and<br />
preliminary lab data, to define each patient’s central physical problem.<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Develop prioritized differential diagnoses, evidence-based diagnostic and<br />
therapeutic plan for common inpatient and ambulatory conditions.<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Make appropriate clinical decisions based on the results of common<br />
diagnostic testing, including but not limited to routine blood chemistries,<br />
hematologic studies, coagulation tests, arterial blood gases, ECG, chest<br />
radiographs, pulmonary function tests, urinalysis and other body fluids.<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Recognize situations with a need for urgent or medical care including life<br />
threatening conditions.<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Recognize when to seek additional guidance.<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Comments:<br />
2. Medical Knowledge<br />
Milestone<br />
Milestone
Identifier<br />
MK-B1<br />
Understand indications for and basic interpretation of common diagnostic<br />
testing, including but not limited to routine blood chemistries, hematologic<br />
studies, coagulation tests, arterial blood gases, ECG, chest radiographs,<br />
pulmonary function tests, urinalysis and other body fluids.<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Comments:<br />
3. Practice Based Learning<br />
Milestone<br />
Identifier<br />
PBLI-C1<br />
PBLI-E1<br />
PBLI-F1<br />
PBLI-H1<br />
Comments:<br />
Milestone<br />
Access medical in<strong>form</strong>ation resources to answer clinical questions and<br />
library resources to support decision making.<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Determine if clinical evidence can be generalized to an individual patient<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Respond welcomingly and productively to feedback from all members of the<br />
health care team including faculty, peer residents, students, nurses, allied<br />
health workers, patients and their advocates.<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Actively participate in teaching conferences.<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
4. Interpersonal and Communication Skills<br />
Milestone<br />
Identifier<br />
ICS-A1<br />
ICS-C1<br />
ICS-D1<br />
ICS-E1<br />
ICS-F1<br />
Milestone<br />
Provide timely and comprehensive verbal and written communication to<br />
patients/advocates.<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Effectively communicate with other care givers in order to maintain<br />
appropriate continuity during transitions of care.<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Deliver appropriate, succinct, hypothesis-driven oral presentations.<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Request consultative services in an effective manner<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Provide legible, accurate, complete, and timely written communication that<br />
is congruent with medical standards<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Comments:<br />
5. Professionalism<br />
Milestone<br />
Milestone
Identifier<br />
P-A1<br />
P-A3<br />
P-F3<br />
P-F5<br />
P-I1<br />
P-J1<br />
Comments:<br />
Document and report clinical in<strong>form</strong>ation truthfully<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Accept personal errors and honestly acknowledge them<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Ensure prompt completion of clinical, administrative, and curricular tasks<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Recognize the scope of his/her abilities and ask for supervision and<br />
assistance appropriately<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Treat patients with dignity, civility and respect, regardless of race, culture,<br />
gender, ethnicity, age or socioeconomic status<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Maintain confidentiality<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
6. Systems Based Practice<br />
Milestone<br />
Identifier<br />
SBP-D1<br />
SBP-D2<br />
SBP-E2<br />
Comments:<br />
Milestone<br />
Reflect awareness of common socio-economic barriers that impact patient<br />
care<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Understand how cost-benefit analysis is applied to patient care (i.e. via<br />
principles of screening tests and the development of clinical guidelines)<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
Minimize unnecessary care including tests, procedures, therapies and<br />
ambulatory or hospital encounters<br />
Needs Improvement Meets Expectations Exceeds Expectations<br />
OVERALL<br />
COMMENTS______________________________________________________________________<br />
Based on this <strong>eval</strong>uation, what are three things the resident needs to improve on the most?<br />
1.<br />
2.<br />
3.<br />
Other Comments:
______________________________________________________________________________________<br />
________________________________________________________________________________<br />
______________________________________________________________________________________<br />
______________________________________________________________________________________<br />
______________________________________________________________________________________<br />
My attending discussed this survey with me: Yes No<br />
__________________________________________________________________________________
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