Clinical Trainee Performance Evaluation Form
Supervisor evaluation of clinical trainee performance. Please complete all sections to provide a comprehensive assessment.
Trainee Name
*
First Name
Last Name
Trainee Role/Position
*
Please Select
Medical Student
Resident
Fellow
Nursing Trainee
Other
Supervisor Name
*
First Name
Last Name
Evaluation Period
*
Overall Performance Rating
*
1
2
3
4
5
Evaluation of Core Competencies
*
Rows
Unsatisfactory
Needs Improvement
Meets Expectations
Exceeds Expectations
Clinical Knowledge
1
2
3
4
Patient Care Skills
5
6
7
8
Professionalism
9
10
11
12
Communication Skills
13
14
15
16
Teamwork
17
18
19
20
Reliability and Punctuality
*
Consistently Reliable
Usually Reliable
Occasionally Unreliable
Frequently Unreliable
Professional Attitude
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Readiness for Increased Responsibility
*
Ready
Needs More Experience
Not Ready
Additional Comments or Recommendations
Submit Evaluation
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