Training evaluation

New Provider Trainee Evaluation Form

We appreciate your time and dedication in helping provide excellent care to the patients of the YK Delta. Please use this form to rate your experience training our new provider. Your review will help guide additional training needs and focus areas for this employee. Please rate the provider on a scale of 1-5 where 1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A if you did not have the opportunity to observe this area.

Question Title

* Please enter the name of the person being evaluated.

Question Title

* Please enter your name.

Question Title

* Medical Expert
1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

	1	2	3	4	5	N/A
Clinical Knowledge	Clinical Knowledge 1	Clinical Knowledge 2	Clinical Knowledge 3	Clinical Knowledge 4	Clinical Knowledge 5	Clinical Knowledge N/A
Data gathering (History and Physical Examination)	Data gathering (History and Physical Examination) 1	Data gathering (History and Physical Examination) 2	Data gathering (History and Physical Examination) 3	Data gathering (History and Physical Examination) 4	Data gathering (History and Physical Examination) 5	Data gathering (History and Physical Examination) N/A
Choice and use of ancillary tests (e.g. Lab tests, imaging, etc.)	Choice and use of ancillary tests (e.g. Lab tests, imaging, etc.) 1	Choice and use of ancillary tests (e.g. Lab tests, imaging, etc.) 2	Choice and use of ancillary tests (e.g. Lab tests, imaging, etc.) 3	Choice and use of ancillary tests (e.g. Lab tests, imaging, etc.) 4	Choice and use of ancillary tests (e.g. Lab tests, imaging, etc.) 5	Choice and use of ancillary tests (e.g. Lab tests, imaging, etc.) N/A
Soundness of judgement and clinic decision	Soundness of judgement and clinic decision 1	Soundness of judgement and clinic decision 2	Soundness of judgement and clinic decision 3	Soundness of judgement and clinic decision 4	Soundness of judgement and clinic decision 5	Soundness of judgement and clinic decision N/A
Performance under emergency conditions	Performance under emergency conditions 1	Performance under emergency conditions 2	Performance under emergency conditions 3	Performance under emergency conditions 4	Performance under emergency conditions 5	Performance under emergency conditions N/A
Self-assessment ability (insight)	Self-assessment ability (insight) 1	Self-assessment ability (insight) 2	Self-assessment ability (insight) 3	Self-assessment ability (insight) 4	Self-assessment ability (insight) 5	Self-assessment ability (insight) N/A
Performs diagnostic and therapeutic procedures required in the rotation	Performs diagnostic and therapeutic procedures required in the rotation 1	Performs diagnostic and therapeutic procedures required in the rotation 2	Performs diagnostic and therapeutic procedures required in the rotation 3	Performs diagnostic and therapeutic procedures required in the rotation 4	Performs diagnostic and therapeutic procedures required in the rotation 5	Performs diagnostic and therapeutic procedures required in the rotation N/A
Minimizes risk and discomfort to patients	Minimizes risk and discomfort to patients 1	Minimizes risk and discomfort to patients 2	Minimizes risk and discomfort to patients 3	Minimizes risk and discomfort to patients 4	Minimizes risk and discomfort to patients 5	Minimizes risk and discomfort to patients N/A

Other (please specify)

Question Title

* Communicator
1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

	1	2	3	4	5	N/A
Establishes therapeutic relationship with patients / families	Establishes therapeutic relationship with patients / families 1	Establishes therapeutic relationship with patients / families 2	Establishes therapeutic relationship with patients / families 3	Establishes therapeutic relationship with patients / families 4	Establishes therapeutic relationship with patients / families 5	Establishes therapeutic relationship with patients / families N/A
Delivers understandable information to patients / families	Delivers understandable information to patients / families 1	Delivers understandable information to patients / families 2	Delivers understandable information to patients / families 3	Delivers understandable information to patients / families 4	Delivers understandable information to patients / families 5	Delivers understandable information to patients / families N/A
Maintains professional relationship with other health care providers	Maintains professional relationship with other health care providers 1	Maintains professional relationship with other health care providers 2	Maintains professional relationship with other health care providers 3	Maintains professional relationship with other health care providers 4	Maintains professional relationship with other health care providers 5	Maintains professional relationship with other health care providers N/A
Provides effective counseling to patients / families	Provides effective counseling to patients / families 1	Provides effective counseling to patients / families 2	Provides effective counseling to patients / families 3	Provides effective counseling to patients / families 4	Provides effective counseling to patients / families 5	Provides effective counseling to patients / families N/A
Provides clear and complete charting and reports	Provides clear and complete charting and reports 1	Provides clear and complete charting and reports 2	Provides clear and complete charting and reports 3	Provides clear and complete charting and reports 4	Provides clear and complete charting and reports 5	Provides clear and complete charting and reports N/A

Other (please specify)

Question Title

* Collaborator
1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

	1	2	3	4	5	N/A
Demonstrates ability to accept and respects opinions of others	Demonstrates ability to accept and respects opinions of others 1	Demonstrates ability to accept and respects opinions of others 2	Demonstrates ability to accept and respects opinions of others 3	Demonstrates ability to accept and respects opinions of others 4	Demonstrates ability to accept and respects opinions of others 5	Demonstrates ability to accept and respects opinions of others N/A
Works effectively in a team environment	Works effectively in a team environment 1	Works effectively in a team environment 2	Works effectively in a team environment 3	Works effectively in a team environment 4	Works effectively in a team environment 5	Works effectively in a team environment N/A
Consults effectively with other specialists and providers	Consults effectively with other specialists and providers 1	Consults effectively with other specialists and providers 2	Consults effectively with other specialists and providers 3	Consults effectively with other specialists and providers 4	Consults effectively with other specialists and providers 5	Consults effectively with other specialists and providers N/A

Other (please specify)

Question Title

* MANAGER
1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

	1	2	3	4	5	N/A
Manages time effectively	Manages time effectively 1	Manages time effectively 2	Manages time effectively 3	Manages time effectively 4	Manages time effectively 5	Manages time effectively N/A
Allocates health care resources effectively	Allocates health care resources effectively 1	Allocates health care resources effectively 2	Allocates health care resources effectively 3	Allocates health care resources effectively 4	Allocates health care resources effectively 5	Allocates health care resources effectively N/A
Works effectively within the health care organization	Works effectively within the health care organization 1	Works effectively within the health care organization 2	Works effectively within the health care organization 3	Works effectively within the health care organization 4	Works effectively within the health care organization 5	Works effectively within the health care organization N/A
Utilizes information technology effectively	Utilizes information technology effectively 1	Utilizes information technology effectively 2	Utilizes information technology effectively 3	Utilizes information technology effectively 4	Utilizes information technology effectively 5	Utilizes information technology effectively N/A
Effectively navigates external systems used to provide patient care	Effectively navigates external systems used to provide patient care 1	Effectively navigates external systems used to provide patient care 2	Effectively navigates external systems used to provide patient care 3	Effectively navigates external systems used to provide patient care 4	Effectively navigates external systems used to provide patient care 5	Effectively navigates external systems used to provide patient care N/A
Practices evidence-based medicine	Practices evidence-based medicine 1	Practices evidence-based medicine 2	Practices evidence-based medicine 3	Practices evidence-based medicine 4	Practices evidence-based medicine 5	Practices evidence-based medicine N/A

Other (please specify)

Question Title

* HEALTH ADVOCATE
1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

	1	2	3	4	5	N/A
Is attentive to preventive measures	Is attentive to preventive measures 1	Is attentive to preventive measures 2	Is attentive to preventive measures 3	Is attentive to preventive measures 4	Is attentive to preventive measures 5	Is attentive to preventive measures N/A
Is attentive to issues of public health	Is attentive to issues of public health 1	Is attentive to issues of public health 2	Is attentive to issues of public health 3	Is attentive to issues of public health 4	Is attentive to issues of public health 5	Is attentive to issues of public health N/A
Advocates on behalf of patients	Advocates on behalf of patients 1	Advocates on behalf of patients 2	Advocates on behalf of patients 3	Advocates on behalf of patients 4	Advocates on behalf of patients 5	Advocates on behalf of patients N/A
Involves patients / families in decision-making	Involves patients / families in decision-making 1	Involves patients / families in decision-making 2	Involves patients / families in decision-making 3	Involves patients / families in decision-making 4	Involves patients / families in decision-making 5	Involves patients / families in decision-making N/A

Other (please specify)

Question Title

* SCHOLAR
1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

	1	2	3	4	5	N/A
Attends and contributes to rounds, seminars, and learning events	Attends and contributes to rounds, seminars, and learning events 1	Attends and contributes to rounds, seminars, and learning events 2	Attends and contributes to rounds, seminars, and learning events 3	Attends and contributes to rounds, seminars, and learning events 4	Attends and contributes to rounds, seminars, and learning events 5	Attends and contributes to rounds, seminars, and learning events N/A
Accepts and acts on constructive feedback	Accepts and acts on constructive feedback 1	Accepts and acts on constructive feedback 2	Accepts and acts on constructive feedback 3	Accepts and acts on constructive feedback 4	Accepts and acts on constructive feedback 5	Accepts and acts on constructive feedback N/A
Takes an evidence-based approach to the management of problems	Takes an evidence-based approach to the management of problems 1	Takes an evidence-based approach to the management of problems 2	Takes an evidence-based approach to the management of problems 3	Takes an evidence-based approach to the management of problems 4	Takes an evidence-based approach to the management of problems 5	Takes an evidence-based approach to the management of problems N/A

Other (please specify)

Question Title

* PROFESSIONAL
1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

	1	2	3	4	5	N/A
Recognizes limitations and seeks advice when needed	Recognizes limitations and seeks advice when needed 1	Recognizes limitations and seeks advice when needed 2	Recognizes limitations and seeks advice when needed 3	Recognizes limitations and seeks advice when needed 4	Recognizes limitations and seeks advice when needed 5	Recognizes limitations and seeks advice when needed N/A
Discharges duties and assignments responsibly and in a timely manner	Discharges duties and assignments responsibly and in a timely manner 1	Discharges duties and assignments responsibly and in a timely manner 2	Discharges duties and assignments responsibly and in a timely manner 3	Discharges duties and assignments responsibly and in a timely manner 4	Discharges duties and assignments responsibly and in a timely manner 5	Discharges duties and assignments responsibly and in a timely manner N/A
Reports facts accurately, including own errors	Reports facts accurately, including own errors 1	Reports facts accurately, including own errors 2	Reports facts accurately, including own errors 3	Reports facts accurately, including own errors 4	Reports facts accurately, including own errors 5	Reports facts accurately, including own errors N/A
Maintains appropriate boundaries in work and learning situations	Maintains appropriate boundaries in work and learning situations 1	Maintains appropriate boundaries in work and learning situations 2	Maintains appropriate boundaries in work and learning situations 3	Maintains appropriate boundaries in work and learning situations 4	Maintains appropriate boundaries in work and learning situations 5	Maintains appropriate boundaries in work and learning situations N/A
Attends duties and reports to work regularly (Punctual)	Attends duties and reports to work regularly (Punctual) 1	Attends duties and reports to work regularly (Punctual) 2	Attends duties and reports to work regularly (Punctual) 3	Attends duties and reports to work regularly (Punctual) 4	Attends duties and reports to work regularly (Punctual) 5	Attends duties and reports to work regularly (Punctual) N/A

Other (please specify)

Training evaluation

New Provider Trainee Evaluation Form

Question Title

* Please enter the name of the person being evaluated.

Question Title

* Please enter your name.

Question Title

* Medical Expert1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

Question Title

* Communicator1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

Question Title

* Collaborator1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

Question Title

* MANAGER1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

Question Title

* HEALTH ADVOCATE1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

Question Title

* SCHOLAR1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

Question Title

* PROFESSIONAL1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

Question Title

* Please enter any additional comments or concerns.

* Medical Expert
1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

* Communicator
1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

* Collaborator
1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

* MANAGER
1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

* HEALTH ADVOCATE
1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

* SCHOLAR
1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.

* PROFESSIONAL
1=Unsatisfactory, 2=Needs improvement, 3=Meets Expectations, 4=Exceeds expectations, 5=Complete Mastery or N/A.