Resident Name (Last, First) Class 2017 2018 2019 2020 Year of Residency One Three Current Specialty - Select -AnesthesiologyDermatologyEmergency MedicineFamily MedicineGeneral SurgeryInternal MedicineMedicine-PediatricsMedicine-PreliminaryMedicine-PsychiatryNeurological SurgeryNeurologyObstetrics-GynecologyOphthalmologyOrthopaedic SurgeryPathologyPediatricsPhysical Medicine & RehabPlastic SurgeryPsychiatryRadiology-DiagnosticTransitionalUrologyVascular Surgery General Fund of Knowledge for Level of Training - Select -1 - Unsatisfactory23 - Below Average45 - Satisfactory67 - Above Average8910 - Outstanding 1 being unsatisfactory, 10 being outstanding Basic understanding of disease processes Problem Strength Please check strength or serious problem in below if score in general fund of knowledge is less than 5 or greater than 8 Basic understanding of the mechanisms of therapy Problem Strength Please check strength or serious problem below if score in general fund of knowledge is less than 5 or greater than 8 Clinical Performance - Select -1 - Unsatisfactory23 - Below Average45 - Satisfactory67 - Above Average8910 - Outstanding 1 being unsatisfactory, 10 being outstanding Patient care skills, including all procedure and technical skills specific to your specialty Problem Strength Please check strength or serious problem below if score in clinical performance is less than 5 or greater than 8 Interpersonal skills Problem Strength Please check strength or serious problem below if score in clinical performance is less than 5 or greater than 8 Communication skills Problem Strength Please check strength or serious problem below if score in clinical performance is less than 5 or greater than 8 Clinical reasoning/decision making Problem Strength Please check strength or serious problem below if score in clinical performance is less than 5 or greater than 8 Professionalism - Select -1 - Unsatisfactory23 - Below Average45 - Satisfactory67 - Above Average8910 - Outstanding 1 being unsatisfactory, 10 being outstanding Self-directed learning habits Problem Strength Please check strength or serious problem below if score in professionalism is less than 5 or greater than 8 Relationships with patients and their families Problem Strength Please check strength or serious problem below if score in professionalism is less than 5 or greater than 8 Relationships with other medical personnel Problem Strength Please check strength or serious problem below if score in professionalism is less than 5 or greater than 8 Reliability and dependability Problem Strength Please check strength or serious problem below if score in professionalism is less than 5 or greater than 8 Ability to assume appropriate responsibility Problem Strength Please check strength or serious problem below if score in professionalism is less than 5 or greater than 8 Emotional stability Problem Strength Please check strength or serious problem below if score in professionalism is less than 5 or greater than 8 Please rate the resident's overall performance in comparison to other residents at the same level of training in your program now. - Select -Top quartile - (top 25%)Second quartileThird quartileBottom quartile - (bottom 25%) Would you take this graduate into your program as a resident again? Yes No Would you seek out other graduates from SIUSOM based on your experiences? Yes No Please add any further comments you wish to make with respect to any other aspects of the resident’s work that you regard as relevant. Your name and address
