ࡱ> % ubjbjSS 71xAd1xAd| 0008hd02B``(AAAAAAA$EGzAAHA 1 1 1A 1A 1 1>A@@u#?AB02B1?0Hp*0H(A@0HA@\ 1AA 12B0H : Resident: Click here to enter text.Date of CCC: Click here to enter a date.Training Level:Choose an item.Date of PD Evaluation: Click here to enter a date.Evaluation Type:Choose an item.Evaluation Period:Enter date.toEnter date.  Block RotationPGY-1PGY-2PGY-3PGY-4Block 1Block 2Block 3Block 4Block 5Block 6Block 7Block 8Block 9Block 10Block 11Block 12Block 13RITE ResultsPGY-2PEER AVGPGY-3PEER AVGPGY-4PEER AVGClinical Assessments (NEX)Critical Care(( acceptable ( unacceptableAmbulatory(( acceptable ( unacceptableNeuromuscular(( acceptable ( unacceptableNeurodegenerative(( acceptable ( unacceptableChild Neurology for Adult Neurology Resident(( acceptable ( unacceptableResident Responsibilities *Anything marked as unacceptable or below Expectations require an action planUnacceptable*Below Expectations*Acceptable*Comments/Action Plan Evaluations and procedures logged and on time?(((Duty Hour Management? (Compliance, time-away, conferences, etc.) (((Didactic/Conference Attendance (minimum of 70% required)(((Actual:  Clinical Competency Committees Evaluation of Resident on Milestones Patient CarePAPE11.522.533.544.55NYRHistory((((((((((Neurologic Examination((((((((((Management/Treatment((((((((((movement disorders((((((((((neuromuscular disorders((((((((((Cerebrovascular disorders((((((((((cognitive/behavioral disorders((((((((((demyelinating Disorders((((((((((epilepsy((((((((((headache syndromes((((((((((neurologic manifestations of systemic disease((((((((((child neurology for adult neurologists((((((((((neuro-oncology((((((((((psychiatry for adult neurologist((((((((((neuroimaging((((((((((electroencephalography (eeg)((((((((((nerve conduction studies (ncs)/electromyography (emg)((((((((((lumbar puncture((((((((((Medical KnowledgePAPE11.522.533.544.55NYRLocalization((((((((((Formulations((((((((((Diagnostic Investigation((((((((((ProfessionalismPAPE11.522.533.544.55NYRcompassion, intergrity, accountibility, and respect for self and others((((((((((Knowledge about, respect for, and adherence to the ethical principles relevant to the practice of medicine, remembering in particular that responsiveness to patients that supersedes self-interest is an essential aspect of medical practice((((((((((Interpersonal and Communication SkillsPAPE11.522.533.544.55NYRrelationship development, teamwork, and managing conflict((((((((((information sharing, gathering, and technology((((((((((Practice-based Learning and ImprovementPAPE11.522.533.544.55NYRSelf directed learning((((((((((locate, appraise, and assimilate evidence from scientific studies related to patients health problems((((((((((Systems-based PracticePAPE11.522.533.544.55NYRSystems thinking, including cost and risk effective practice((((((((((work in interprofessional teams to enhance patient safety((((((((((PA-Peer Average (same PGY level) PE- Previous Evaluation NYR- Not yet rotatedCOMMENTS: GOALS and ACTION PLANSCompleted Research/Scholarly Activity: Additional Comments on training:Notable Extras: Points for Improvement: Previous Personal Learning Plan and Goals: Achieved/CompletedWork in ProgressNot Started1. (((2. (((3. (((New Personal Learning Plan and Goals: (Please include any work in progress or not started goals from last year)  Please sign this form only if you have read and fully understand all information included in this evaluation.Click here to enter text. (Program Director)Click here to enter text.(Resident) *Include this section for final summative evaluation Graduation RequirementsGME Courses: ( Bioethics ( Proven Care ( Quality Basics ( Personal & Practice ManagementOther Quality and Safety Courses: Year attended National Conference:(PGY-1 (PGY-2 ( PGY-3 ( PGY-4 Rotations Completed1 month2 months3 months4 months5 months6 monthsOutpatient (excluding Continuity Clinic)((((((Inpatient((((((Remaining Clinical Adult Neurology((((((Child Neurology(((Psychiatry(Elective(((     Resident:  Training Level:  Evaluation Type:6 Month EvaluationAcademic Year:2014-2015  PAGE \* MERGEFORMAT 2  Neurology Residency Program Neurology Resident Evaluation 2014-2015  PAGE \* MERGEFORMAT 1  $%023NPY^_`opx{         ' + , 4 8 Ȼꧣzrzrhwihh: hwih3hwihh5hwih4u5hwihh;hwihh;CJh^ hwihhhwihhCJ^JaJhwihS)CJ^JaJhwih^CJ^JaJ hwih^ hwih= hwih[;hwih0Jhwih[;CJ^JaJ, %3Od$Ifgdwil OP`pD,,,d$Ifgdwil kd$$IfTl\hF'| t0'644 lap(ytwiT,kdD$$IfTl\h'` V )  t0'644 lap(ytwiTd$Ifgdwil 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