EMS Non-Faculty Monthly Fellow Evaluation
 
 

Fellow Being Evaluated:
Evaluation Dates:  
Evaluator Name:



Patient Care

1) How would you rate the fellow's knowledge and judgement as it relates to prehospital patient care?
  Unsatisfactory Below Average Average Above Average Superior N/A
 
  Comments:


2) Would you let the fellow take care of a family member?
  Never Only with attending
in close supervision
If family member was
not gravely ill
In any case, with
minimal supervision
Without hesitation
 
  Comments:


Professionalism


3) How would you describe the Fellow's overall attitude towards prehospital providers?
  Poor: Demeaning,
unreasonable,
demanding
Below Average Generally
Respectful
Above Average Excellent: Treats
prehospital providers with respect and understanding
N/A
 
  Comments:


4) How is the fellow at conflict resolution with prehospital providers, support staff, and families?
  Often lets conflicts
escalate. Does not
take an active role in
problem situations
Attempts to
resolve
conflicts, but
not soon
enough
Tries to resolve
conflicts early,
Will intervene if
asked
Attemps
to disarm
difficult
situations

Very adept at
disarming hostile
situations.
Actively involves self
in potential conflicts

 

N/A
 
  Comments:


Interpersonal and Communication Skills


5) How receptive is the fellow to receiving information or opinions from you?
  Very
resistant
to input
Listens, but is
resistant to
change
Will listen if offered;
may act on
information
Listens,
occasionally
seeks counsel

Actively seeks input
and tries to react
appropriately

 

N/A
 
  Comments:


6) Does the fellow respond to your opinions or actions in a constructive manner?
  Usually
critical
of staff
Mainly critical of
staff, but
occasionally
constructive
Feedback is
sometimes given.
May be constructive
or critical
Mainly
constructive,
occasionally
complimentary

Always tries to
give constructive
feedback.
Complimentary

 

N/A
 
  Comments:


7) Does the fellow make efforts to include you in discussion of medical issues and patient planning?
  Virtually never
teaches. Does
not include in
planning
Teaches,
but not
well
Will teach if
asked,
informs of
planning
Teaches appropriately;
providers occasionally
involved in decision
making

Frequently teaches
without prompting and
includes providers in
decision making

 

N/A
 
  Comments:


8) Is the fellow approachable for questions or concerns regarding patient care, personal care, personal interaction, or department issues?
  Not
approachable.
Does not value
provider
concerns
Approachable,
but providers
hesitate to
approach
Generally
approachable.
Acknowledges
concerns
Available for
questions
and
concerns

Always available
for questions
and responds
appropriately to
concerns

N/A
 
  Comments:


9) How would you rate this fellows actions in the prehospital environment?
  Unsatisfactory Below Average Average Above Average

Superior

N/A
 
  Comments:


Medical Knowledge


10) How do you rate this fellows' knowledge base as it relates to EMS?
  Unsatisfactory Below Average Average Above Average Superior
 
  Comments:


11) How do you grade this fellows' ability to provide prehospital medical direction?
  Unsatisfactory Below Average Average Above Average Superior
 
  Comments:


12) How would you rate this fellows' ability to perform patient care in a professional and ethical manner?
  Unsatisfactory Below Average Average Above Average Superior
 
  Comments:


Practice-Based Learning and Improvement


13) To what degree do you feel that this fellow is able to identify his or her own strengths, deficiencies, and limits in knowledge and expertise?
  Unsatisfactory Below Average Average Above Average Superior
 
  Comments:


14) Do you feel that the fellow drives safely?  If "No", please specify why in the Comments field below.
  YES NO N/A  
   
  Comments:



Overall Comments: