SPHMMC Family Medicine Program

Neonatology Attachment Evaluation

Name of Resident___________________________ Evaluation Period_________________________
Year of Residency___________________________ Hospital ________________________________

Scoring: 1 – never demonstrates this skill, behaviour or attitude; 2 – rarely demonstrates this skill, behaviour or attitude; 3 – sometimes
demonstrates this skill, behaviour or attitude; 4 – usually demonstrates this skill, behaviour or attitude; 5 - always demonstrates this skill,
behaviour or attitude. Note: mark “N/A” if you have not observed the resident in a particular capacity.
Assessment Mark /5 Mark /5 Average N/A Comments
Evaluator-1 Evaluator-2
MEDICAL EXPERT
Clinical knowledge
Conducts appropriate Hx and P/E of
infants and children
Demonstrates a competent ap-
proach to common conditions of in-
fancy and childhood
Demonstrates a competent ap-
proach to life-threatening conditions
in neonates, children
Performs common diagnostic pro-
cedures well
Demonstrates commitment to infant
and child growth, development, and
disease prevention
PROFESSIONAL CONDUCT AND RE-
LATIONSHIP
Effective doctor-patient relationship
Communicates well with the health-
care team
Professional ethics, discharge of re-
sponsibilities
PRESENTATION
Quality of presentation
SCHOLAR
Ability to supervise juniors, stu-
dents, etc.
Teaching activity and interest
ATTENDANCE Full attendance Missed 1 day without Missed 2 Missed >2 Absence during
(contact FM lead if 1 day or missed 1-2 adequate explanation days days this attachment
or more missed without days with ex- without ad- without ad- impacted learn-
explanation) planation equate ex- equate ex- ing
planation planation

Should resident pass this attach- Pass (above or equal to 70%) Repeat (60-69%) Fail (Less than 60%)
ment?

Strengths:
Weaknesses:
Evaluator(s) Name(s) 1.________________________ Signature___________________________

2. _______________________ Signature___________________________

Total Score (Calculated by Family Medicine Dept):________________________