Prison Medicine - The College of Family Physicians Canada

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Version March 12, 2008J. APPENDIX 4: UBC Family Practice Residency ProgramResident WebEval Evaluation – Prison Medicine ElectiveTo be completed by supervisor for this electiveResident: ___________________________________Rotation: Prison medicine electiveFaculty Supervisor for this elective______________________Dates on Service: ___________________________________A. Discussion of Program Objectives (see: http://www.familypractice.ubc.ca) Date: ______B. Resident’s personal objectives for this rotation: Were they met/completed?1. ________________________________________ ________________________________________2. ________________________________________ ________________________________________3. ________________________________________ ________________________________________4. ________________________________________ ________________________________________C. Mid-Rotation EvaluationDate: ______________________________Comments:D. General Evaluation:CategoryUnabletoJudgeNeedsImprovementAverageAboveAverageExceptionalCommentsA FAMILY PHYSICIAN IS A SKILLEDCLINICIANKnowledge Has knowledge appropriate to levelof training. Uses knowledge effectively1 2 3 4 5 6 7 8 9 10Assessment Performs appropriatehistory/physician assessment Plans appropriate investigationsProblem Solving Successfully integrates knowledgeand assessmentManagement Creates appropriate managementplanProcedural Skills Proficient in procedures appropriateto this elective Aware of indications andcontraindications for procedures2/3/20122/3/2012 Page 10 of 10 11
Version March 12, 2008CategoryUnabletoJudgeNeedsImprovementAverageAboveAverageExceptionalCommentsTHE DOCTOR-PATIENTRELATIONSHIP IS CENTRAL TO THEROLE OF THE FAMILY PHYSICIANProfessionalism Demeanour, Timekeeping, etc.MotivationInterest, initiative, attendanceSelf Awareness Aware of limitations Appropriate confidence Functions independently1 2 3 4 5 6 7 8 9 10 Patient Centred Empathises with patient and familyTHE FAMILY PHYSICIAN ISCOMMUNITY BASEDInterpersonal Skills Works effectively with health careteam Interacts effectively with staff andancillary workers Aware of community resourcesspecific to this elective1 2 3 4 5 6 7 8 9 10THE FAMILY PHYSICIAN IS ARESOURCE TO A DEFINED PRACTICEPOPULATIONLearning Self directs learning based on patientencounters Presents effective, well researchedrounds/case presentationsE. Rotation-Specific Learning Outcomes:1 2 3 4 5 6 7 8 9 10Has the Resident demonstrated a level of competence appropriate to level of training?(see program website for rotation –specific learning outcomes)□ Yes □ No □ Unable to AssessGeneral Comments:Overall Evaluation□ Needs Improvement □ Meets Expectations □ Exceeds Expectations(Note: An unsatisfactory evaluation must be discussed with the Resident and the Site Director).□ Pass □ Fail2/3/20122/3/2012 Page 11 of 11
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Prison Medicine - The College of Family Physicians Canada

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