**[EVALUATION OF ANATOMIC PATHOLOGY RESIDENTS]{.underline} (to be
completed by the Attending Senior Physician)**

Fellow\'s Name Time Period Evaluated

Evaluator\'s Name Date of
Evaluation\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Please evaluate the trainee\'s ability to carry out the following
clinical tasks. Cite the major strengths and weaknesses observed under
the \"Comments\" portion.

Circle the rating which best describes the trainee\'s skills and
abilities for each component of clinical competence.

+------------------------+--------------------+-----------------------+
| **1. CLINICAL          | Unsatisfactory     | Regularly integrates  |
| JUDGMENT**             | Satisfactory       | medical facts and     |
|                        | Superior           | clinical data, weighs |
| Often fails to discern |                    | alternatives,         |
| relationship of        | 1 2 3 4 5 6 7 8 9  | understands           |
| medical facts and      |                    | limitations of        |
| clinical data,         |                    | knowledge, and        |
| evaluate alternatives, |                    | incorporates          |
| or consider risks and  |                    | consideration of      |
| benefits. Does not     |                    | risks and benefits.   |
| understand limitations |                    | Spends time           |
| of his/her knowledge   |                    | appropriate to the    |
| or skills. Poorly      |                    | complexity of the     |
| established            |                    | problem.              |
| priorities. Illogical, |                    | Presentations,        |
| rambling, incomplete,  |                    | records, and          |
| or inaccurate          |                    | consultation notes    |
| presentations or       |                    | always accurate,      |
| medical records.       |                    | responsive, explicit, |
|                        |                    | and concise.          |
| Indecisive in          |                    |                       |
| difficult management   |                    |                       |
| situations.            |                    |                       |
+------------------------+--------------------+-----------------------+
| 2.  **MEDICAL          | Unsatisfactory     | Extensive and well    |
|     KNOWLEDGE**        | Satisfactory       | applied. Consistently |
|                        | Superior           | up-to-date. Resident  |
| Limited, poorly        |                    | demonstrates          |
| organized.             | 1 2 3 4 5 6 7 8 9  | knowledge of          |
|                        |                    | biomedical, clinical  |
|                        |                    | and social sciences,  |
|                        |                    | and applies that      |
|                        |                    | knowledge effectively |
|                        |                    | to patient care.      |
|                        |                    | Understands complex   |
|                        |                    | relationships and     |
|                        |                    | mechanisms of         |
|                        |                    | disease.              |
+------------------------+--------------------+-----------------------+
| 3.  **PROCEDURAL       | Unsatisfactory     | Always proficient.    |
|     SKILLS**           | Satisfactory       | Minimizes risk and    |
|                        | Superior           | discomfort to         |
| Inept. Frequent        |                    | patients. Proper      |
| disregard for risk to  | 1 2 3 4 5 6 7 8 9  | explanation of        |
| patient and clinical   |                    | purposes.             |
| protocols.             |                    |                       |
+------------------------+--------------------+-----------------------+
| **4. PRATICE-BASED     | Unsatisfactory     | Resident uses         |
| LEARNING**             | Satisfactory       | evidence and methods  |
|                        | Superior           | to investigate,       |
|                        |                    | evaluate, and improve |
|                        | 1 2 3 4 5 6 7 8 9  | his/her patient care  |
|                        |                    | practices. Able to    |
|                        |                    | incorporate feedback  |
|                        |                    | into improvement      |
|                        |                    | activities; uses      |
|                        |                    | technology to manage  |
|                        |                    | information for       |
|                        |                    | patient.              |
+------------------------+--------------------+-----------------------+

+------------------------+--------------------+-----------------------+
| **5. HUMANISTIC        | Unsatisfactory     | Always demonstrates   |
| QUALITIES**            | Satisfactory       | integrity, respect,   |
|                        | Superior           | compassion, and       |
| Lacks appropriate      |                    | empathy for patients. |
| integrity, respect,    | 1 2 3 4 5 6 7 8 9  | Establishes trust.    |
| compassion, empathy.   |                    | Primary concern is    |
| Displays insensitivity |                    | for the patient's     |
| and intolerance.       |                    | welfare. Maintains    |
| Abuses trust, and      |                    | credibility and       |
| demonstrate            |                    | excellent rapport.    |
| unreliability. Poor    |                    |                       |
| rapport with           |                    |                       |
| clinicians. Fails to   |                    |                       |
| obtain proper consent  |                    |                       |
| documents and          |                    |                       |
| approvals.             |                    |                       |
+------------------------+--------------------+-----------------------+
| **6. PROFESSIONAL      | Unsatisfactory     | Provides effective    |
| BEHAVIOR**             | Satisfactory       | communication.        |
|                        | Superior           | Responsive, reliable, |
| Frequently             |                    | committed,            |
| irresponsible and      | 1 2 3 4 5 6 7 8 9  | cooperative, and      |
| uncommitted.           |                    | respectful. Regard    |
| Ineffective            |                    | for opinions and      |
| communication.         |                    | skills of             |
| Disruptive and         |                    | professional          |
| disrespectful to other |                    | colleagues.           |
| health care            |                    | Demonstrates ethical  |
| professionals. Shows   |                    | behavior. Resident    |
| disdain for referring  |                    | demonstrates          |
| physicians. Flares at  |                    | behaviors that        |
| criticism.             |                    | reflect an ongoing    |
|                        |                    | commitment to         |
|                        |                    | continuous            |
|                        |                    | professional          |
|                        |                    | development, ethical  |
|                        |                    | practice, sensitivity |
|                        |                    | to diversity, and     |
|                        |                    | responsible           |
|                        |                    | attitudes. Commitment |
|                        |                    | to self-assessment    |
|                        |                    | and acknowledgement   |
|                        |                    | of error.             |
+------------------------+--------------------+-----------------------+
| **7. INTERPERSONAL AND | Unsatisfactory     | Resident demonstrates |
| COMMUNICATION SKILLS** | Satisfactory       | these skills and      |
|                        | Superior           | maintains             |
|                        |                    | professional and      |
|                        | 1 2 3 4 5 6 7 8 9  | therapeutic           |
|                        |                    | relationships with    |
|                        |                    | patients and the      |
|                        |                    | healthcare team.      |
|                        |                    | Demonstrates          |
|                        |                    | listening, narrative  |
|                        |                    | and nonverbal skills. |
|                        |                    | Educates and counsels |
|                        |                    | patient.              |
+------------------------+--------------------+-----------------------+
| **8. MEDICAL CARE**    | Unsatisfactory     | Identifies all the    |
|                        | Satisfactory       | diagnostic problems.  |
| Pedestrian diagnostic  | Superior           | Establishes sensible  |
| ability. Inattentive   |                    | differential          |
| to details. Miss major | 1 2 3 4 5 6 7 8 9  | diagnoses. Provides   |
| problems. Incomplete   |                    | orderly succession of |
| analysis plans.        |                    | analysis and          |
|                        |                    | recommendations.      |
|                        |                    | Educates referring    |
|                        |                    | physicians.           |
+------------------------+--------------------+-----------------------+
| **9. TEAM LEADERSHIP** | Unsatisfactory     | Effective leadership. |
|                        | Satisfactory       | Recognized as able,   |
| Insensitive to         | Superior           | decisive, and,        |
| complementary roles of |                    | authoritative by team |
| technicians,           | 1 2 3 4 5 6 7 8 9  | members. Delegates    |
| consulting physicians, |                    | responsibility        |
| and other team         |                    | appropriately.        |
| members. Ineffective   |                    | Receptive to clinical |
| day-to-day and crisis  |                    | and administrative    |
| management of team.    |                    | input from other team |
| Inconsistent in        |                    | members. Strong       |
| leadership role and in |                    | interpersonal skills. |
| delegation of          |                    |                       |
| authority.             |                    |                       |
+------------------------+--------------------+-----------------------+
| **10. COMMITMENT TO    | Unsatisfactory     | Appropriate reference |
| SCHOLARSHIP**          | Satisfactory       | to the medical        |
|                        | Superior           | literature at         |
| Parrots lessons of the |                    | conferences and on    |
| past. Satisfied with   | 1 2 3 4 5 6 7 8 9  | clinical rounds.      |
| current fund of        |                    | Constructive          |
| knowledge. Little      |                    | skepticism. Good      |
| evidence of reading.   |                    | teaching reputation.  |
| Bored with theoretical |                    | Enthused and          |
| concepts or            |                    |                       |
| pathophysiological     |                    |                       |
| explanations.          |                    |                       |
| stimulated by new      |                    |                       |
| comprehensions.        |                    |                       |
+------------------------+--------------------+-----------------------+
| **11. SYSTEM BASED     | Unsatisfactory     | Resident demonstrates |
| LEARNING**             | Satisfactory       | both an understanding |
|                        | Superior           | of the contexts and   |
|                        |                    | systems in which      |
|                        | 1 2 3 4 5 6 7 8 9  | health care is        |
|                        |                    | provided and applies  |
|                        |                    | this knowledge to     |
|                        |                    | improve and optimize  |
|                        |                    | health care. Uses     |
|                        |                    | systematic approaches |
|                        |                    | to reduce errors and  |
|                        |                    | improve patient care. |
+------------------------+--------------------+-----------------------+
| **12. ATTENTION TO     | Unsatisfactory     | Writes compulsive     |
| ADMINISTRATIVE NEEDS** | Satisfactory       | notes and maintains   |
|                        | Superior           | logbooks in an        |
| Fails to maintain      |                    | organized, legible,   |
| progress notes, case   | 1 2 3 4 5 6 7 8 9  | accurate manner in    |
| reports, consultation  |                    | accordance            |
| logbook, and other     |                    |                       |
| records in a           |                    |                       |
| consistent and legible |                    |                       |
| fashion. with          |                    |                       |
| departmental rules and |                    |                       |
| regulations.           |                    |                       |
+------------------------+--------------------+-----------------------+
| 13. **PARTICIPATION IN | Unsatisfactory     | Regularly attends     |
|     DEPARTMENTAL       | Satisfactory       | administrative and    |
|     PROGRAMS**         | Superior           | educational           |
|                        |                    | functions,            |
| Rarely attends         | 1 2 3 4 5 6 7 8 9  | participates actively |
| conferences, lectures, |                    | in meetings and       |
| and meetings; arrives  |                    | rounds, and is        |
| late or leaves early   |                    | consistently          |
| without adequate       |                    | punctual.             |
| reason.                |                    |                       |
+------------------------+--------------------+-----------------------+

**PART B. Anatomic Pathology Rating Categories.**

Please provide a numerical score and narrative comments regarding the
following topics related to anatomic pathology skills, attitude and
accomplishments.

+------------------------+--------------------+-----------------------+
| **1. Progress in       | Unsatisfactory     |                       |
| pathology diagnostic   | Satisfactory       |                       |
| skills (patient        | Superior           |                       |
| care)**                |                    |                       |
|                        | 1 2 3 4 5 6 7 8 9  |                       |
+------------------------+--------------------+-----------------------+
| **2. Quality of        | Unsatisfactory     |                       |
| pathology diagnostic   | Satisfactory       |                       |
| write-ups**            | Superior           |                       |
|                        |                    |                       |
|                        | 1 2 3 4 5 6 7 8 9  |                       |
+------------------------+--------------------+-----------------------+
| **3. Efficiency of     | Unsatisfactory     |                       |
| case completion**      | Satisfactory       |                       |
|                        | Superior           |                       |
|                        |                    |                       |
|                        | 1 2 3 4 5 6 7 8 9  |                       |
+------------------------+--------------------+-----------------------+
| **4. Quality of        | Unsatisfactory     |                       |
| conference             | Satisfactory       |                       |
| presentations**        | Superior           |                       |
|                        |                    |                       |
|                        | 1 2 3 4 5 6 7 8 9  |                       |
+------------------------+--------------------+-----------------------+
| **5. Communications    | Unsatisfactory     |                       |
| with staff and         | Satisfactory       |                       |
| clinicians**           | Superior           |                       |
|                        |                    |                       |
|                        | 1 2 3 4 5 6 7 8 9  |                       |
+------------------------+--------------------+-----------------------+
| **6. Personality and   | Unsatisfactory     |                       |
| attitude toward fellow | Satisfactory       |                       |
| residents and staff**  | Superior           |                       |
|                        |                    |                       |
|                        | 1 2 3 4 5 6 7 8 9  |                       |
+------------------------+--------------------+-----------------------+
| **7. Research          | Unsatisfactory     |                       |
| accomplishments**      | Satisfactory       |                       |
|                        | Superior           |                       |
|                        |                    |                       |
|                        | 1 2 3 4 5 6 7 8 9  |                       |
+------------------------+--------------------+-----------------------+
| **8. Professional      | Unsatisfactory     |                       |
| accomplishments**      | Satisfactory       |                       |
|                        | Superior           |                       |
|                        |                    |                       |
|                        | 1 2 3 4 5 6 7 8 9  |                       |
+------------------------+--------------------+-----------------------+

**Is there any reason to question this trainee\'s honesty, integrity, or
suitability to practice anatomic pathology? Yes (please explain) No**

**OVERALL RATING AS A SUBSPECIALIST IN ANATOMIC PATHOLOGY OVERALL
RATING: \_\_\_\_\_\_\_\_**

**PERFORMANCE NOTES: Based on the above ratings of each component skill,
please provide comments about the trainee\'s overall performance.**

# I have received and reviewed this evaluation\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

#  Signature Date