Mid-Rotation Feedback

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This form was developed to facilitate a discussion about your performance with an attending during the rotation. Throughout your residency training it is important for you to elicit as much feedback as possible from your faculty. You are expected to receive real time feedback near the midpoint of all rotations.

Faculty Name (Last)

Resident Name (First, Last) *

Rotation *

Select 3 areas in which you would like to improve through the remainder of the rotation (Resident to complete) *

Communication skills

Interpersonal relationships (faculty, staff, or peers/learners)

Medical Knowledge (Diagnosis)

Medical Knowledge (Treatment)

Use of Evidence Based Medicine

Procedural Skills

Documentation Skills

Professionalism

Self-awareness of limits

Teaching skills

Prioritization and delegation of tasks

Organizational skills

Responsiveness to constructive criticism or feedback

Self-Directed Learning (Reading) and if so, how/what

Leadership skills

Other:

Required

Select 3 areas which you believe to have been strengths thus far in the rotation for the resident (Faculty to Complete) *

Communication skills

Interpersonal relationships (faculty, staff, or peers/learners)

Medical Knowledge (Diagnosis)

Medical Knowledge (Treatment)

Use of Evidence Based Medicine

Procedural Skills

Documentation Skills

Professionalism related to timeliness

Self-awareness of limits

Teaching skills

Prioritization and delegation of tasks

Organizational skills

Responsiveness to constructive criticism or feedback

Self-Directed Learning (Reading) and if so, how/what

Leadership skills

Other:

Required

Please feel free to list any additional feedback (Faculty)

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