Internship and Residency Program Evaluation
Please rate the each of the following program elements, using the scales noted for each section and subsection. Section I Faculty and Staff: 0 = No Opinion 1 = Inadequate 2 = Fairly Adequate, but Needs Work 3 = Neutral 4 = Adequate 5 = Exceeded Expectations
Please rate the each of the following program elements, using the scales noted for each section and subsection.
Section I
Faculty and Staff:
0 = No Opinion 1 = Inadequate 2 = Fairly Adequate, but Needs Work 3 = Neutral 4 = Adequate 5 = Exceeded Expectations
Comments on Faculty and Staff: (please comment and suggest changes if applicable) . Section II Academic Program: Please answer YES or NO to the following two questions.
Comments on Faculty and Staff: (please comment and suggest changes if applicable)
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Section II
Academic Program: Please answer YES or NO to the following two questions.
0 = No Opinion 1 = Completely Inadequate 2 = Fairly Adequate, but Needs Work 3 = Neutral 4 = Adequate 5 = Exceeded Expectations
Comments on Academic Program: (list recommendations for change) . Section III Patient Care: 0 = No Opinion 1 = Insufficient 2 = Neutral 3 = Sufficient 4 = Excessive
Comments on Academic Program: (list recommendations for change)
Section III
Patient Care:
0 = No Opinion 1 = Insufficient 2 = Neutral 3 = Sufficient 4 = Excessive
0 = No Opinion 1 = Disagree 2 = Neutral 3 = Agree
Call duties average no more than 1 of 3 nights (averaged over a 4 week period)
One day a week (on average) is free of clinical responsibilities
My average workweek does not exceed 80 hours (averaged over a 4 week period)
There is an appropriate balance between patient care activities and education
Comments on Patient Care: (please comment and/or recommend changes) . Section IV Supervision/Consultation 0 = No Opinion 1 = Completely Inadequate 2 = Inadequate 3 = Neutral 4 = Adequate 5 = Exceeded Expectations
Comments on Patient Care: (please comment and/or recommend changes)
Section IV
Supervision/Consultation
0 = No Opinion 1 = Completely Inadequate 2 = Inadequate 3 = Neutral 4 = Adequate 5 = Exceeded Expectations
Availability of faculty supervision on all rotations
Availability of supervision by senior residents/fellows on all rotations
Appropriateness of responsibilities to my level of training
My interactions with residents from other specialties have been positive
Comments on Supervision/Consultation: (please comment and/or recommend changes) Section V
Comments on Supervision/Consultation: (please comment and/or recommend changes)
Section V
What are the best aspects of this residency program?
"If I could change one thing about this residency it would be..."
Thank you for completing this evaluation!