Appendix 3 – Trainee Evaluation

The Indo-American Cancer Association and Pallium India - Appendix 3 Evaluation of the trainee by the Director

Please evaluate the fellow's performance of each component of the General Competencies. Select the rating which best describes the fellow's skills and abilities. Identify the major strengths and weaknesses you have observed in the trainee's performance in the comments spaces.

1 = STRONGLY DISAGREE - He/she makes poor decisions or has an unsatisfactory approach to solving problems that results in poor care delivery or unacceptable behavior. He/she displays problems with integrity, trustworthiness, compassion, or respectfulness. He/she does not appear capable of understanding concepts, exercising judgment and/or demonstrating behaviors that are important to achieve competence for the element being evaluated.

2 = SOMEWHAT DISAGREE - He/she governed by rules, but not capable of utilizing experience to address circumstances that are unexpected or non-typical or he/she inconsistently uses experience to guide decisions or actions. He/she deals effectively with routine, repetitive or non-stressful situations but requires supervision in more difficult or challenging circumstances. Limited internal resources and thus, requires guidance and supervision for most decisions.

3 = NEITHER AGREE OR DISAGREE - He/she utilizes learned principles and applies them to guide actions in usual or typical circumstances. He/she has developed adequate internal resources upon which he/she can rely to make competent decisions in routine cases. Recognizes his/her limitations and accesses support when needed, especially for more challenging situations. This is the level expected from those at the completion of training and indicates that they can effectively address the majority of routine situations and will access support when needed in other cases.

4 = SOMEWHAT AGREE - He/she utilizes principles and applies them to guide actions in unusual or challenging circumstances. Is consistently trusted to deal effectively with complex problems. He/she has developed enough internal understanding that they can handle challenging situations without the need for external support.

5 = STRONGLY AGREE- He/she can recognize errors or inadequacies in knowledge, judgment or behavior in complex situations and is capable of effective remediation. He/she is a persuasive lifelong learner. He/she understands the contextual "whole" and is fluid and flexible in performance.



* Required
Name of the Centre *
Choose
Trivandrum Institute of Palliative Sciences, Thiruvananthapuram
MNJ Institute of Oncology, Hyderabad
Tata Memorial Hospital, Mumbai
Gujarat Cancer Research Institute, Ahmedabad
Cipla Palliative Care and Training Center, Pune
CanSupport, New Delhi
Kasturba Medical College, Manipal, Karnataka
Name of the Trainee *
Your answer
Profession *
Required
PATIENT CARE
Did you complete an orientation with this trainee in outlining the educational goals and objectives of this course? *
Required
Able to take a complete medical history and perform a careful and accurate physical examinations with a symptom control and palliative care focus? *
Strongly Disagree
Strongly Agree
Can define and prioritize patients' medical problems and generate appropriate differential diagnoses *
Strongly Disagree
Strongly Agree
Able to manage symptoms and develop treatment plans in a rational and evidence based manner *
Strongly Disagree
Strongly Agree
Able to participate in end-of-life concerns with patients and their families being respectful of patient preference, counseling and educating patients and offering information *
Strongly Disagree
Strongly Agree
MEDICAL KNOWLEDGE
Able understand the basic pathophysiology, clinical manifestations, diagnosis and management of pain and other symptoms in cancer and non-cancer patients *
Strongly Disagree
Strongly Agree
Is familiar with the basic principles of medical care of patients needing palliative care *
Strongly Disagree
Strongly Agree
Understands the indications for and basic interpretation of standard laboratory tests, including blood counts, blood chemistry tests, urinalysis, body fluid analysis, microbiologic tests *
Strongly Disagree
Strongly Agree
PRACTICE BASED LEARNING
Is able to use information technology; educate students and other professionals *
Strongly Disagree
Strongly Agree
Committed to professional scholarship, including systematic and critical perusal of relevant print and electronic literature, with an emphasis on integration and evaluation of information in light of the principles of evidence-based medicine *
Strongly Disagree
Strongly Agree
INTERPERSONAL AND COMMUNICATION SKILL
Communicates effectively with patients and families *
Strongly Disagree
Strongly Agree
Communicates effectively with physician colleagues at all levels *
Strongly Disagree
Strongly Agree
Communicates effectively with all non-physician members of the health care team to assure comprehensive and timely care of patients *
Strongly Disagree
Strongly Agree
Accepts professional responsibility as the primary care physician for patients under his/her care *
Strongly Disagree
Strongly Agree
Appreciates social text of illness *
Strongly Disagree
Strongly Agree
Understands ethical concepts of confidentiality, consent, autonomy, and justice *
Strongly Disagree
Strongly Agree
SYSTEMS-BASED PRACTICE
Understands and utilizes the multidisciplinary resources necessary to care optimally for hospitalized patients *
Strongly Disagree
Strongly Agree
Collaborates with other members of the health care team to assure comprehensive patient care *
Strongly Disagree
Strongly Agree
Understands when to ask for help and advice from senior staff and consultants *
Strongly Disagree
Strongly Agree
Knows when and how to request consultation and utilise the advice from other para-medical services *
Strongly Disagree
Strongly Agree
Considers cost-effectiveness of diagnostic and treatment strategies *
Strongly Disagree
Strongly Agree
Willing to engage and share information with rest of the team *
Strongly Disagree
Strongly Agree
OVERALL
Has adequate Clinical Competence *
Strongly Disagree
Strongly Agree
COMMENTS *
Your answer
Submit
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