OFF-SERVICE RESIDENT EVALUATION FORM

Name   Service/School    Date

Name of Evaluator
 
 Item
Outstanding
 Top 90% (must comment)
Excellent
 70-90%ile
 
Good
 15-69%ile
 
Doubtful
 1-14%ile (must comment)
Unsatisfactory
<1%ile (must comment)
I. Medical Knowledge 
II. Professional Judgment 
III.Skills
   Patient Work Up
   Technical
   Interpersonal
   Dependability

Written Comments
PLEASE LEAVE SOME WRITTEN COMMENTS THESE ARE EXTREMELY VALUABLE!!