Medical Residency Fellowship Evaluation Form
Please complete this form to evaluate the performance of a medical residency or fellowship trainee. All fields are designed to capture a comprehensive assessment.
Trainee Name
*
Evaluator Name
*
Relationship to Trainee
*
Please Select
Attending Physician
Fellowship Director
Peer Resident/Fellow
Other
Overall Clinical Competence
*
1
2
3
4
5
Professionalism
*
Unsatisfactory
1
2
3
4
Excellent
5
1 is Unsatisfactory, 5 is Excellent
Communication Skills
*
Poor
1
2
3
4
Outstanding
5
1 is Poor, 5 is Outstanding
Teamwork and Collaboration
*
Rarely
1
2
3
4
Always
5
1 is Rarely, 5 is Always
Detailed Evaluation of Key Competencies
*
Rows
Below Expectations
Meets Expectations
Exceeds Expectations
Medical Knowledge
1
2
3
Patient Care
4
5
6
Practice-Based Learning
7
8
9
Systems-Based Practice
10
11
12
Would you recommend this trainee for advancement or completion of the program?
*
Yes
No
With Reservations
Comments and Suggestions for Improvement
Submit Evaluation
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