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Sports Medicine Fellowship Evaluation |
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XYZ Sports Center |
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Fellow’s
Name ______________________
Rotation Dates ______________________ Evaluator’s Name ____________________ Evaluator’s Location _________________ |
Please us the following grading scales by fill=
ing in
the appropriate square with the corresponding number. 6 =3D= 60% -- Unacceptable Performance 7 =3D= 70% -- Acceptable Performance 8 =3D= 80% -- Meets Expectations 9 =3D= 90% -- Exceeds Expectations 10 =3D 100% - Outstanding N/A – Not Applicable |
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GENERAL
OBJECTIVES
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6
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7
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8
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9
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10
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N/A
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1. Demonstrates profess=
ional
appearance
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2. &n=
bsp; Communicates/relates
to physicians and staff in a professional manner.
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3. &n=
bsp; Appreciates
the need for privacy, dignity and respect for the patient.
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4. &n=
bsp; Shows
evidence of being a self motivated learner.
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5. &n=
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accurate up-to date medical records.
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6. &n=
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and discussed published objectives for this rotation. |
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CLINICAL SPORTS MEDICINE FELLOWSHIP EVALUATION
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Orthopedics |
6 |
7 |
8 |
9 |
10 |
N/A |
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1. <= /span>Perform clinical orthopedic evaluation On the following: |
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&nbs= p; a. Upper Extremities= |
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&nbs= p; b. Low Back |
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&nbs= p; c. Hip |
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&nbs= p; d. Knee |
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&nbs= p; e. Leg |
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&nbs= p; f. Ankle |
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&nbs= p; g. Foot |
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2. <= /span>Perform open and closed reduction of Fractures/dislocations = under supervision. |
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3. Perform or assist with large and small joint arthroscopic procedures. |
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4. <= /span>Identify indications and limitations of rehabilitation programs associated with |
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5. Recognize physiatrist role in evaluation and management of lower extremity |
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6. <= /span>Identify principles associated with Orthopedic concerns in = the following: |
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&nbs= p; a. Sekeletally immature athlete |
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&nbs= p; b. Geriatric athlete= |
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&nbs= p; c. Female athlete |
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Educational Quality Assurance |
YES |
NO |
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1. =
; Were the rotation
objectives clearly |
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2. =
; Was the Fellow adequ=
ately
prepared for this rotation ? |
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ŸPass &=
nbsp; Ÿ<=
/span> Fail
COMMENTS:
___________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= _______________________
___________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= _______________________________________________________________
________________________________________________ &= nbsp; &nbs= p; &= nbsp; &nbs= p; _____________________
Evaluato=
r’s
Signature &nbs=
p; &=
nbsp; &nbs=
p; &=
nbsp; &nbs=
p; &=
nbsp; Date