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AMERICAN OSTEOPATHIC ASSOCIATION
PEDIATRIC PROGRAM DIRECTOR'S ANNUAL REPORT

INSTRUCTIONS:

As part of its efforts to monitor the educational progress of residents, the American Osteopathic Association asks that you complete a program director’s annual report on each osteopathic physician in your program.  These reports are reviewed by the specialty colleges and become part of the resident’s permanent file.  Completion of a residency program requires an annual report from the resident and program director for each year of training.

Please evaluate the performance of the resident within thirty (30) days of the completion of the training year.  The completed report should be sent directly to the appropriate specialty college.

 

Report Period: to

RESIDENT INFORMATION
   
Name of Resident:
AOA#:
Specialty:
Resident E-mail Address:
Confirm Resident E-mail Address:
PGY: 1 2 3 Other
   
   
PROGRAM DIRECTOR INFORMATION
   
Program Director:
Phone Number:
E-Mail Address:
Confirm E-Mail Address:
Training Institution:
Mailing Address:
 
   
RESIDENT COMPETENCIES RATINGS
 
Please score each area with a 1-9 rating  (1 lowest  -- 9 highest)
 
OSTEOPATHIC PHILOSOPHY AND OMT
 
  1. Demonstrates competency in the understanding and application of OMT where appropriate.
  2. Integrates osteopathic concepts into the medical care provided to patients as appropriate.
 
MEDICAL KNOWLEDGE
 
  1. Demonstrates competency in the application of clinical medicine to patient care.
  2. Knows and applies the foundations of clinical and behavioral medicine.
  3. Demonstrates knowledge of accepted standards of care.
  4. Remains current with new developments in medicine.
  5. Participates in life-long learning activities.
 
PATIENT CARE
 
  1. Gathers accurate, essential information from all sources.
  2. Demonstrates competency in the performance of diagnostic and treatment procedures.
  3. Provides health care services that includes preventative medicine and health promotion.
 
INTERPERSONAL / COMMUNICATION SKILLS
 
  1. Demonstrates effectiveness in developing appropriate doctor-patient relationships.
  2. Exhibits effective listening, written and oral communication skills
 
PROFESSIONALISM
 
  1. Demonstrates respect for patients / families and acts as their advocate.
  2. Adheres to ethical principles in the practice of medicine.
  3. Is sensitive to cultural diversity i.e. religion, age, gender, sexual orientation, and disabilities.
  4. Is cognizant of their own physical and mental health in order to effectively care for patients.
 
PRACTICE-BASED LEARNING
 
  1. Treats patients in a manner consistent with current and evidence based information.
  2. Performs self-evaluations of clinical practice.
  3. Understands research methods, medical informatics, and the application of technology.
 
SYSTEMS-BASED PRACTICE
 
  1. Understands national and local health care delivery systems.
  2. Advocates for quality health care on behalf of patients.
  3. Practices cost effective medicine.
 
Resident Examination
 
  1. What scholarly activity of this resident have you reviewed and approved?  (See article IV section H of Basic Standards for residency training in pediatrics)
    Please specify
  2. Has the resident completed the resident clinical evaluation in a satisfactory manner during this training year?
    Yes No  N/A
  3. Has the resident established a panel of patients followed throughout the year in a continuity clinic setting?
    Yes    No    N/A
    Indicate the number of patients in the panel:
    Comment:
  4. Please evaluate the resident in terms of progress in the program, promise as a physician, and in other areas not specifically mentioned above.

  5. Does this confirm that the resident has completed this year of training?
    Yes    No
  6. Has this resident made satisfactory progress in current training period?   Yes    No    N/A
  7. Is he/she capable to proceed into the next year?  If no, please submit quarterly evaluations. Yes    No
  8. The graduating resident has successfully completed all requirements of the training program, and is recommended for program complete status.  Yes    No    N/A

    If no, explain:
 
Signature
 

By checking this box contitutes as your signature.
By checking this box you verify that the resident has had the opportunity to review this report.

Date: / / (mm/dd/yyyy)