Medical Intern Performance Evaluation Form
Please complete this form to evaluate the performance of a medical intern. All feedback should be professional and non-sensitive.
Intern's Full Name
*
First Name
Last Name
Evaluator's Full Name
*
First Name
Last Name
Department/Rotation
*
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Medical Knowledge
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Clinical Skills
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Professionalism
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Communication Skills
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Teamwork and Collaboration
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Additional Comments or Recommendations
Submit
Should be Empty: