ALBERTA CHILDREN’S HOSPITAL

PAEDIATRIC EMERGENCY MEDICINE ROTATION

INTERIM EVALUATION

Resident Name _________________________ Rotation Dates _________

Home Program _________________________ Level ________

Preceptors: Please review evaluations to date and provide a summary

evaluation of first half of rotation.

Evaluation Codes:

1 – Below expectations for level of training

2 – Meeting expectations for level of training

3 – Outstanding resident (functioning in top 10% of peers)

Medical Expert: Comments:

History and physical exam _____

Recognition of seriously ill child _____

Ability to formulate differential _____

Investigation & management plans _____

Communicator:

Communication with families and pts _____

Written reports _____

Collaborator:

Team relationships (MDs RNs unit clerks) _____

Manager:

Follows up on own patients _____

Scholar: Knowledge of the literature _____

Professionalism:

Sense of responsibility _____

Recognition of own limitations _____

Ability to receive feedback _____

Ethical behavior _____

Overall Competency: _____

Completed by: _____________________________ Date: __________________

Please have preceptor complete at end of shift.