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8/7/2019 observership-program-evaluation
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The importance of an accurate and honest
Observership Program evaluation
The program that your international medical graduate (IMG) observer has just completed will affect
his/her career in many ways. Being able to function within the U.S. health care system and observing thedelivery of care firsthand are invaluable experiences, but there are additional benefits tied to the quality of
the evaluation you deliver.
A thoughtful and honest evaluation can provide valuable feedback to the observer with respect to how his
or her performance has been perceived. This will allow the observer to work on any areas of weakness or
deficiency in a focused manner. Ideally, the observer should have received a brief formative evaluation
midway through the observership in order to address such issues before receiving this final summative
evaluation. At that time, they also should have been given a copy of this evaluation form to understand
how and in what areas they will be evaluated.
This evaluation can also provide program directors with critical information to help them narrow the large
field of applicants they consider each year. For the Observership Program to have value and contributemeaningfully to the process of helping IMGs obtain positions in U.S. residency programs, however,
evaluations must be accurate and not inflated. Therefore, it’s important to take a few moments after the
weeks of hard work you and your assigned observer have completed, to provide an honest review that
will serve these purposes.
The list of knowledge and skills to be evaluated may look overwhelming at first but by working through
each one and using the examples of behavior, this evaluation should be completed in five to 10 minutes.
Thank you for taking the time to complete a fair and honest evaluation.
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Completing the Observership Program evaluation form
1. Familiarize yourself with the descriptions of the Overall levels of performance (below):
2. When reviewing each item, first determine if it is relevant to the observer’s experience and/or if there was
sufficient observation to evaluate. If not, check the “NA/NO” box (meaning “not applicable” or “not observed”)and move to the next item.
3. For each item that is determined applicable to your observer and for which there was adequate observation to
evaluate, read the examples under the Needs improvement, Acceptable and Strong levels of performance.
Determine which of those three levels best describes the IMG observer.
4. Within the level you’ve selected, check one of the three numbered boxes (the higher the number, the higher your
evaluation). Check only one box for each area being evaluated.
5. Include written comments when possible, especially if the observer is rated very high or very low for an item.
6. Include any general comments or observations in the space provided at the end of the form.
7. You may choose to review the completed form with the IMG observer to provide more detailed feedback.
8. Return the form to: _______________________________________________________________________.
Overall levels of knowledge, skills or professional attributes
Needs improvementMay encounter problems in achieving
required performance levels
AcceptableHas or can be expected to achieve
required performance levels
StrongAlready demonstrates performance ator above required performance levels
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Observership evaluation
Observer name __________________________________________________________________________
Preceptor name __________________________________________________________________________
Nature of Observership (internal medicine, surgery, pediatrics, etc.)
________________________________________________________________________________________
Dates of Observership ____/_____/_____ to ____/_____/______
Institution(s) where Observership occurred
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Evaluation based on:
______ Personal observations
______ Additional input from
________________________________________________________________________________________
________________________________________________________________________________________
Evaluation submitted (date) _____/_____/_______
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Knowledge and skillsPage 1 of 4
Needs improvement Acceptable Strong
Knowledge –basic medicalscience
Significant deficits in knowledge of relevant anatomy and physiology;trouble recalling or applying principlesof basic sciences in clinical settings.
Working knowledge of relevantanatomy and physiology; adequaterecall of basic principles of clinicallyrelevant basic sciences
Solid grasp of relevant anatomy andphysiology; demonstrates evidence ofregular application of principles of allbasic sciences to clinically relevantsituations
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Knowledge –clinical science
Lacks basic understanding of principlesof clinical medicine including basicpathophysiology and therapeutics
Good grasp of principles of clinicalmedicine despite some gapsconsistent with limited experience or level of training
Clear understanding of clinicalmedical principles, consistently able toarticulate pathophysiology and relateto logical diagnostics and therapeutics
NA/NO
1 2 3
4 5 6
7 8 9Comments:
Knowledge –medical educationresources
Familiarity with standard textbook andreferences is incomplete; difficultyaccessing medical literature andsearching and retrieving relevantinformation; interpretation of studyresults often flawed
Is familiar with standard textbooksand references, can access medicalliterature both in library andelectronically; can search andretrieve relevant information; caninterpret results of studies
Well versed and familiar with allcomponents of medical literatureincluding standard texts, referencesand peer-reviewed journals; searchesare focused and efficient andconsistently retrieve relevantinformation; critically appraises resultsof studies
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Knowledge –health caresystem
Often appears confused by elements of US Healthcare system, has troubleintegrating new elements even with aappropriate explanation, may beunaware of significant components;oblivious to or confused by health carefinancing system
Demonstrates basic understandingof the US Healthcare system, able tointegrate new elements withappropriate explanation, comfortablewith most commonly encounteredelements; basic appreciation of implications of health care financingsystem
Demonstrates clear understanding of the US Healthcare system, able toeffectively relate componentsincluding those less frequentlyencountered; demonstrates andexpresses awareness of implicationsof health care financing system
NA/NO1 2 3
4 5 6
7 8 9
Comments:
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Knowledge and skillsPage 2 of 4
Knowledge –U.S. formulary
Often appears confused by names,dosages and indications for commonlyused drugs in U.S. formulary;
frequently using names of drugs fromprior education or practice setting; littleor no familiarity with pharmacologicalreferences.
Can apply basic knowledge of clinicalpharmacology to identifyingappropriate drugs in U.S. formularies
that may differ in name, dosages or indications from those in their prior country of training or practice; somefamiliarity with pharmacologicalreferences..
Demonstrates sound knowledge of names, dosages and indications of alcommonly used drugs in U.S.
formulary with no evidence of confusion with drugs used previouslyfacility with using pharmacologicalreferences
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Needs improvement Acceptable Strong
Skills – clinical
skills – medicalhistory
Beginning with specifics not related toCC or HPI; makes no effort to clarify
unintelligible or inadequate answers;reasonable associations of symptomsnot pursued; ignores obvious riskfactors; pursues low yield informationor fails to pursue critical information;random questions in no logical order
Starts with specifics but thoseidentified in CC or HPI; reposes
questions to inadequate answers;broad pursuit of potential relatedsymptoms but not necessarily specificto case; generally explores commonrisk factors; follows up on mostimportant information; questions insome order and lead from general tospecific
Initially broad inquiries followed byspecifics as indicated by CC and
HPI; rephrases patient responses or offers similes to clarify inadequateanswers; sequential questioning of associated symptoms and pursuit of associations which may not beintuitive; thoroughly explores all riskfactors; selective use of followupquestions with deeper probing of critical information; clearly organizedpattern of questions from general tospecific
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Communication –patients andfamilies
May express impatience withdifficulties in understanding or beingunderstood; may use medical jargonwithout explanation; may conveydisdain toward some; critical of beliefsor attitudes that do not conform to own
Makes efforts to understand and beunderstood; rarely uses medical jargon; generally respectful inaddressing; is open to diverse beliefsand attitudes toward health
Consistently confirms thatunderstanding is clear by repetition,soliciting questions; explains anymedical terminology used; alwaysrespectful in addressing; genuineeffort to understand and respectdiverse beliefs and attitudes
NA/NO1 2 3
4 5 6
7 8 9
Comments:
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Knowledge and skillsPage 3 of 4
Communication –colleagues
May be overly deferential towardsuperiors and/or dismissive of peers;conversations and discussions may be
minimal and often tangential or inappropriate; may be evasive whenquestioned; resistant to new ideas andapproaches
Respectful of superiors and peers;conversations and discussions aregenerally relevant and appropriate,
answers questions forthrightly, opento diverse ideas and approaches,
Treats all colleagues respectfullywhether superiors or peers; activelyparticipates in conversations and
discussions without trying todominate or show off; welcomesquestions and challenges; activelysolicits different points of view andrationales
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Communication –nursing andancillary staff
Shows little interest in understandingrole and expertise of staff; rarely if ever approaches staff for help or information and may ignore or dismisssuggestions when made; may bedisrespectful or make disparaging
remarks about staff; quick to blamestaff for lack of knowledge or performance
Acknowledges role and expertise of staff and accepts suggestions; mayoccasionally approach staff for help or information; treats staff with respect;rarely criticizes or blames staff for lackof knowledge or performance
Makes efforts to learn the role andexpertise of staff; actively solicits stafinformation and help and takessuggestions gracefully; treats staff respectfully as colleagues; oftencompliments staff on knowledge and
skills
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Clinical skills –communication -spoken Englishproficiency
Frequent problems withcomprehension and understanding dueto rate of speech, extreme accent or errors in syntax, little or no effort toadapt to listeners or clarify, maybecome annoyed or upset whenmisunderstood
Generally comprehensible, accentmay be obvious but not problematic,makes effort to adapt rate of speechand pronunciation to listener, mayattempt to incorporate idioms althoughnot always successful
Virtually no difficulty incomprehension even if accent ispresent, confirms understanding of listener by repetition or clarification asnecessary, reasonable facility withincorporation of idioms
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Clinical skills –communication –written
Handwritten entries frequently illegible,spelling and syntax errors hamper comprehensibility;essentially unable to enter material viakeyboard or does so with multipleunproofed errors
Handwritten entries are legible,occasional spelling and syntax errors;entry by keyboard may be slow anderror prone but final drafts arereasonably proofed
Handwriting consistently legible withaccurate spelling and syntax;proficient at typing with few errorsand final proof near perfect
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Skills –informationtechnology skills
– electronicmedical records
Has recurrent difficulty accessingelectronic medical records; often
unable to locate relevant information;unable to enter clinical information or does so with frequent errors of formator location.
Is able to access electronic medicalrecords and locate relevant
information; is able to appropriatelyenter basic clinical information intoelectronic medical records
Easily and efficiently accesses andmoves about within electronic
medical records to locate and retrieveinformation and to enter informationin appropriate locations and formats
NA/NO1 2 3
4 5 6
7 8 9
Comments:
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Knowledge and skillsPage 4 of 4
Needs improvement Acceptable Strong
Skills – IT skills –informationretrieval – clinicaldata
Frequently unable to retrieve currentlaboratory results or radiology reportsor retrieves erroneous information, e.g.,wrong patient
Can generally retrieve currentlaboratory results and radiologyreports
Facility with retrieving not onlycurrent laboratory results andradiology reports but also withaccessing older and archivedmaterials
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Skills – IT skills –informationretrieval –
referencematerial
Has difficulty accessing electronic andweb-based resources, frequentlyunable to retrieve necessaryinformation; unfamiliar with or unable to
effectively use search engines
Can retrieve necessary informationfrom electronic and web-basedresources; can construct and carry outreasonable searches using PubMed or
other search engines
Facility with retrieving keyinformation from electronic and web-based resources, frequently in real-time and at point of service; uses
PubMed or other search engines toconduct efficient, comprehensivesearches
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Skills –presentationskills – patientpresentations
Presentation of patients isdisorganized with significant relevantinformation lacking; results of diagnostics not presented or presentedin confusing or unclear manner
Presents patients following traditionalformat, includes relevant informationand results of diagnostics; respondsappropriately to questions
Presents patients following clear andlogical format, relevant informationincludes pertinent positives andnegatives; results of diagnostic testspresented with proposedinterpretations; highly receptive toquestions and comments
NA/NO
1 2 3
4 5 6
7 8 9Comments:
Skills –presentationskills –educationalpresentations
Assigned topic may be misconstruedor unfocused, only rudimentary materialpresented, no or ineffective AVmaterials; unable to respond to manyquestions
Presents topics as assigned, includesbasic required information,presentation is logical, AV materialsare appropriate; able to respond tomost questions
Focuses assigned topics for maximarelevance, materials beyond basicsas appropriate, AV materialssignificantly contribute topresentation; confidently takesquestions and responds appropriately
NA/NO1 2 3
4 5 6
7 8 9
Comments:
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Professional qualitiesPage 1 of 4
Needs improvement
Acceptable
Strong
Professionalqualities –integrity
May be evasive when lackinginformation, may fabricate answers toavoid embarrassment, may attempt totake credit for accomplishments of others
Consistently honest, does notfabricate answers if does not know,does not takes credit for things doneby others
Unswervingly honest, readily admitsand may even volunteer when lackinginformation or answers, acknowledgesaccomplishments of others, mayminimize credit for ownaccomplishments
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Needs improvement
Acceptable
Strong
Professionalqualities –tolerance
Frequently has or expresses negative judgments regarding groups or typesof people, may use derogatory terms,rejects validity of di fferent perspectiveseven when explained
Accepts people of diversebackgrounds, does not expressnegative judgments or use derogatoryterms, acknowledges validity of differing perspectives when explained
Actively attempts to understandperspectives and values of diversegroups, makes efforts to maintainsensitivity to cultural and other interpersonal issues
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Needs improvement
Acceptable
Strong
Professionalqualities –confidentiality
Expresses resistance to or dismissiveness regarding principles of confidentiality, may be careless withpatient related documents, frequentlydiscusses patient information inunsecured areas
Understands and accepts principles of confidentiality, generally careful withpatient related documents, mayoccasionally reference patientinformation in unsecured areas
Values and respects principles of confidentiality, consistentlyconscientious regarding patientrelated documents, never discussespatient information in unsecured areas
NA/NO1 2 3
4 5 6
7 8 9
Comments:
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Professional qualitiesPage 2 of 4
Needs improvement
Acceptable
Strong
Professionalqualities –punctuality
Frequently or persistently late for scheduled activities, considerstardiness not a significant issue
Generally on time for scheduledactivities, understands and acceptsthe importance of punctuality
Always on time for scheduledactivities, may even make a point of arriving a few minutes early, mayarticulate respect for others whichpunctuality bespeaks
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Needs improvement
Acceptable
Strong
Professionalqualities –reliability
Fails to complete tasks assigned or requires repeated reminders andprodding, materials delivered may beinappropriate to requests and/or of unacceptable quality
Generally completes tasks assigned,rarely needs to be reminded or prodded, produces materialsconsistent with requests and of acceptable quality
Consistently completes tasks assignedon or before due dates with no needfor reminders, materials producedconsistently meet and often exceedspecifications, all work is of highestquality
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Needs improvement
Acceptable
Strong
Professionalqualities –initiative
Has difficulty gathering information or completing tasks even after extensivedirections, rarely or never initiatesproposals or offers suggestions
After adequate directionssubsequently is able to gather information or complete tasks withminimal additional guidance,sometimes initiate proposals or offerssuggestions
Can gather information and completetasks after only minimal initialdirection, consistently initiatesproposals and offers suggestions,seeks creative solutions to problems
NA/NO1 2 3
4 5 6
7 8 9
Comments:
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Professional qualitiesPage 3 of 4
Needs improvement
Acceptable
Strong
Professionalqualities –participation
Makes minimal or no contribution todiscussions even when invited or
makes inappropriate or overlyaggressive attempts to dominatediscussions
Makes effort to participate indiscussions and activities althoughmay sometimes require some drawingout or may occasionally tend to beoverly or inappropriately verbose
Consistently contributes meaningfullyto discussions while evidencingrespect for input of others, canappropriately gear level of participation to nature of discussion
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Needs improvement
Acceptable
Strong
Professionalqualities –teamwork
Has great difficulty functioning in ateam framework, may expresssignificant skepticism of the teamconcept or resistance to itsimplementation, recurring problem withdeferring to other team
After adequate introduction, canfunction appropriately within a teamframework, although may have someconfusion regarding team concept or resistance to deferring to other teammembers
A natural team player, evidencesmutual respect and support of all teammembers, able to defer or lead asappropriate, actively acknowledgescontributions of other team
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Needs improvement
Acceptable
Strong
Professionalqualities –receptivity tofeedback
May become overly defensive receivenegative feedback, tends to makeexcuses and blame others, rarely if ever actively seeks feedback
Can accept and respond to bothnegative and positive feedbackalthough may evidence minimaldefensiveness, generally only seeksfeedback following errors or difficulties
Consistently solicits feedback bothnegative and positive, never defensiveor blaming of others for shortcomings,actively attempts to correct problemsand initiates follow-up feedback
NA/NO1 2 3
4 5 6
7 8 9
Comments:
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Professional qualitiesPage 4 of 4
Needs improvement
Acceptable
Strong
Professionalqualities –mindfulness
Fails to recognize limits of knowledgeand skills even when clearly exceeded,unaware of strengths or weaknesses,oblivious to prejudices, and notcapable of self reflection
Can generally recognize limits of knowledge and skills whenchallenged, evidences awareness of strengths and weaknesses andprejudices, capable of self reflectionbut generally only when asked to doso
Accurate and realistic recognition of limits of knowledge and skills, modestlyacknowledges strengths while activelyworking on weaknesses, identifies andresists personal prejudices, regularlyengages in self reflection
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Needs improvement
Acceptable
Strong
Professionalqualities –dedication
Pursuit of knowledge and skills inmedicine is often secondary topersonal issues, tends to minimizetime and effort devoted to training,long-term goals primarily self-centered, rarely evidences genuineconcern for patients
Conscientiously pursues acquisition of knowledge and skills in medicine,evidences willingness to acceptpersonal challenges of training andpractice, evidences genuine concernfor patient's welfare
Enthusiastically seeks outopportunities to increase knowledgeand skills in medicine, evidenceswillingness to devote necessary timeand effort to training and practice butalso maintains healthy balance inlifestyle, active and compassionatepatient advocate
NA/NO1 2 3
4 5 6
7 8 9
Comments:
Needs improvement
Acceptable
Strong
Teachability /Learnability
Requires frequent repetition of mostbasic information, fails to apply generalprinciples to specific cases; resistant tocorrection, defensive to negativefeedback; rarely asks questions, little
or no participation in discussions
Retains new information well, canusually apply principles to specificcases, takes correction and negativefeedback well; asks good questionsand participates in discussions
Actively pursues knowledge andexplores topics on own initiative,effectively applies principles to specificcases, seeks and responds tocorrection and feedback; questions
are incisive and participates activelyand appropriately in discussions
NA/NO1 2 3
4 5 6
7 8 9
Comments:
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Overall Comments
Include any comments, observations or information that you believe would be of value to those who may beassessing this observer as a potential program applicant.
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