Daily Learner Feedback Tool Emergency Medicine 2022-2023

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1. Learner's Name *Please select name from the correct Block Number
(If the learner's name is not listed below, please contact Claudia Jean - Claudia.Jean@nygh.on.ca)

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2. Teacher's Name
(If the teacher's name is not listed below, please contact Claudia Jean - Claudia.Jean@nygh.on.ca)

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3. Teacher's Validation Code

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4. Date of Encounter

Date

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5. Competency
- If you assess the learner as "Below Expectations" in any of the competencies, please document specific examples and contact the rotation supervisor.

	Exceeds Expectations	Meets Expectations	Below Expectations	N/A
Medical Expert (knowledge, history, physical exam, problem formulation)	Medical Expert (knowledge, history, physical exam, problem formulation) Exceeds Expectations	Medical Expert (knowledge, history, physical exam, problem formulation) Meets Expectations	Medical Expert (knowledge, history, physical exam, problem formulation) Below Expectations	Medical Expert (knowledge, history, physical exam, problem formulation) N/A
Medical Expert (procedural skills)	Medical Expert (procedural skills) Exceeds Expectations	Medical Expert (procedural skills) Meets Expectations	Medical Expert (procedural skills) Below Expectations	Medical Expert (procedural skills) N/A
Communicator (written records, oral report, patient/family interaction)	Communicator (written records, oral report, patient/family interaction) Exceeds Expectations	Communicator (written records, oral report, patient/family interaction) Meets Expectations	Communicator (written records, oral report, patient/family interaction) Below Expectations	Communicator (written records, oral report, patient/family interaction) N/A
Collaborator (team participation, role awareness)	Collaborator (team participation, role awareness) Exceeds Expectations	Collaborator (team participation, role awareness) Meets Expectations	Collaborator (team participation, role awareness) Below Expectations	Collaborator (team participation, role awareness) N/A
Leader (appropriate use of resources, efficiency)	Leader (appropriate use of resources, efficiency) Exceeds Expectations	Leader (appropriate use of resources, efficiency) Meets Expectations	Leader (appropriate use of resources, efficiency) Below Expectations	Leader (appropriate use of resources, efficiency) N/A
Advocate (individual patients, population-based)	Advocate (individual patients, population-based) Exceeds Expectations	Advocate (individual patients, population-based) Meets Expectations	Advocate (individual patients, population-based) Below Expectations	Advocate (individual patients, population-based) N/A
Professional (dress, ethics, punctuality, responsible)	Professional (dress, ethics, punctuality, responsible) Exceeds Expectations	Professional (dress, ethics, punctuality, responsible) Meets Expectations	Professional (dress, ethics, punctuality, responsible) Below Expectations	Professional (dress, ethics, punctuality, responsible) N/A

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6. Strengths

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7. Suggestions for Improvements

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8. Rate the learner's overall performance today

Far below expectations
1

Somewhat below expectations
3

As expected
6

Somewhat ahead of level
8

Best learner ever encountered
10

Far below expectations
1

Somewhat below expectations
3

As expected
6

Somewhat ahead of level
8

Best learner ever encountered
10

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9. I acknowledge that I am the teacher listed above and have completed this assessment.

Yes

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1. Learner's Name *Please select name from the correct Block Number(If the learner's name is not listed below, please contact Claudia Jean - Claudia.Jean@nygh.on.ca)

Question Title

2. Teacher's Name(If the teacher's name is not listed below, please contact Claudia Jean - Claudia.Jean@nygh.on.ca)

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3. Teacher's Validation Code

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4. Date of Encounter

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5. Competency- If you assess the learner as "Below Expectations" in any of the competencies, please document specific examples and contact the rotation supervisor.

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6. Strengths

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7. Suggestions for Improvements

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8. Rate the learner's overall performance today

Question Title

9. I acknowledge that I am the teacher listed above and have completed this assessment.

1. Learner's Name *Please select name from the correct Block Number
(If the learner's name is not listed below, please contact Claudia Jean - Claudia.Jean@nygh.on.ca)

2. Teacher's Name
(If the teacher's name is not listed below, please contact Claudia Jean - Claudia.Jean@nygh.on.ca)

5. Competency
- If you assess the learner as "Below Expectations" in any of the competencies, please document specific examples and contact the rotation supervisor.