space.template.Advancement+Committee+Review+Form

** ADVANCEMENT COMMITTEE ** ** RESIDENT EVALUATION REVIEW FORM **
 * MAINE-DARTMOUTH FAMILY MEDICINE RESIDENCY **

Resident: Advisor: Last evaluation date: Evaluation date: Advisor Meeting: Advisor Meeting: Committee member presenting: ¶ Longitudinal curriculum (Nursing home visits)? y/n ¶ Required supplemental study completed? y/n HPI
 * COMMENTS ON INDIVIDUALIZED LEARNING PLAN: **
 * CURRICULUM REQUIREMENTS: **
 * COMPETENCIES: **
 * I. PATIENT CARE **
 * 1 – __Rotation Evaluations__ **
 * 2. __Chart Audits__ **


 * 3. __Patient volume__ **
 * 4. __Procedure logs__ **
 * II. MEDICAL KNOWLEDGE **
 * III. PRACTICE BASED LEARNING **
 * __ Resident evaluations __** –
 * __ Conference attendance __** –
 * IV. INTERPERSONAL AND COMMUNICATION SKILLS **
 * V. PROFESSIONALISM **
 * Face-to-Face meeting with Advisor ** –

¶ **COMMENTS:**
 * Targets for the next evaluation include:**