Physician Candidate Evaluation Form
Please assess the physician candidate based on the criteria below. Your honest and thorough evaluation is appreciated.
Candidate Name
*
Position/Role Being Evaluated
*
Please Select
Resident
Fellow
Attending Physician
Consultant
Other
Clinical Knowledge
*
1
2
3
4
5
Patient Care Skills
*
1
2
3
4
5
Professionalism
*
1
2
3
4
5
Communication Skills
*
1
2
3
4
5
Teamwork and Collaboration
*
1
2
3
4
5
Please rate the candidate on the following competencies:
*
Rows
Excellent
Good
Average
Below Average
Poor
Medical Judgment
1
2
3
4
5
Ethical Conduct
6
7
8
9
10
Adaptability
11
12
13
14
15
Time Management
16
17
18
19
20
Would you recommend this candidate for the position?
*
Highly recommend
Recommend
Recommend with reservations
Do not recommend
Strengths of the candidate
Areas for improvement
Submit Evaluation
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