Faculty Observed: Full Name Select Degree

Department:	Track: ^ Track

Observation Dates:	Evaluation Date: Click or tap to enter a date.

Evaluator: Reviewer Name	Position: Position/Title/Rank

Academic Unit: UA College of Medicine-Tucson Department of Full Name

Purpose of Evaluation: I conducted this observation and evaluation at the physician’s request as a peer evaluation to be considered as part of her promotion and tenure process.

Overall Teaching Effectiveness

Click or tap here to enter text.

Protocol

Pre-observation Meeting

I met with the reviewee before observations were conducted to review the protocol for peer evaluation of teaching, select an observation tool and adapt it as needed. We agreed to use this instrument for the evaluation process.

Observations

I observed the reviewee on multiple occasions in the following settings or clinical services:

☐ During rounds

☐ Outpatient clinic

☐ In the Operating Room

☐ Inpatient Setting

☐ Emergency Department/Trauma Unit

☐ Classroom setting	Please indicate: ☐ Large Group ☐ Small Group

Observations included teaching of the following learners:

☐ Pre-med students	☐ Medical students	☐ Residents ☐ Fellows ☐ Other Click or tap here to enter text.

Evaluation Categories & Scale

Below are several categories included in my observation and evaluation, and upon which my overall evaluation and comments above are based.

The scale concerns the quality of performance and includes a translation of estimated frequency of the occurrence of behaviors for items that are frequency-based. (Example: Failure to perform an expected teaching behavior would be characterized as “Needs Improvement”. A behavior not expected to be observed would be indicated as “Not Evaluated”.)

☐Needs Improvement	☐Somewhat Effective	☐ Effective	☐Very Effective	☐Not Applicable
Not Evident in teaching practice observed	Evident occasionally	Evident some of the time	Evident most of the time	Evident consistently throughout the observations

Assessment of Pertinent Medical Knowledge

Consider qualities such as…

Evaluated resident's ability to apply medical knowledge to specific patients or situations

Evaluated resident's ability to analyze or synthesize medical knowledge

Evaluated resident's knowledge of factual medical information or clinical practice

☐Needs Improvement	☐Somewhat Effective	☐ Effective	☐Very Effective	☐Not Applicable	☐Not Evaluated
Comment:

Assessment of Procedural/Clinical Skills

Consider qualities such as…

Residents were provided with an opportunity for practicing or developing:

communication skills

clinical skills

problem solving skills

Residents were provided guidance, explanations and/or demonstrations of skills

☐Needs Improvement	☐Somewhat Effective	☐ Effective	☐Very Effective	☐Not Applicable	☒Not Evaluated
Comment: …

Interaction with Residents

Consider qualities such as…

Treats residents with respect

Is available as needed in the clinical setting

Is receptive to questions

Encourages active participation in patient care process

Attempts to motivate residents

Varies teaching strategies to fit resident and/or situation

☐Needs Improvement	☐Somewhat Effective	☐ Effective	☐Very Effective	☐Not Applicable	☐Not Evaluated
Comment:

Encourages Residents to become Independent Learners

Consider qualities such as…

Residents are encouraged to:

self-assess their knowledge, skills or understanding

do independent or follow-up learning and/or research

recall, draw on and/or extend prior knowledge

Residents are provided with or directed to learning resources to assist in their improvement

☐Needs Improvement	☐Somewhat Effective	☐ Effective	☐Very Effective	☐Not Applicable	☐Not Evaluated
Comment:

Professionalism

Consider qualities such as…

Demonstrates an interest in the specialty/practice

Demonstrates an interest in teaching

Models professional behavior

Models professional communications with other healthcare professionals

Models provision of standard of patient care specific in varying circumstances

Shares clinical or educational experience with residents to support learning and improvement

☐Needs Improvement	☐Somewhat Effective	☐ Effective	☐Very Effective	☐Not Applicable	☐Not Evaluated
Comment

Constructive Feedback

Consider qualities such as…

Offers evaluative remarks as to whether resident is performing well or needs improvement

Offers residents suggestions for improvements

Feedback is timely

Feedback is critical when necessary but provided in a helpful way

Grading discriminates among different levels or aspects of performance

☐Needs Improvement	☐Somewhat Effective	☐Effective	☐Very Effective	☐Not Applicable	☐Not Evaluated
Comment:

Approach to Teaching

Consider qualities such as…

Expectations or objectives for resident performance are clearly communicated

Time in clinic is used effectively for teaching residents

Visual aids and technology are used as needed and/or as feasible

Activities in clinic rotation relate clinic practice to literature or theory or standard of clinical practice

Clinic uses relevant examples to explain key concepts or highlight clinical practices

☐Needs Improvement	☐Somewhat Effective	☐Effective	☐Very Effective	☐Not Applicable	☐Not Evaluated
Comment: As stated above, While teaching medical student

Strengths

Areas for Development or Improvement

________________________________________________

Reviewer Full Name

Select Title/Rank

UA College of Medicine-Tucson

Department of

Email:	Type email	Phone: Enter Phone

[ ] I have read the foregoing evaluation and acknowledge that I met with the evaluator before the evaluation process to discuss the process and evaluation form, and after observations to review the evaluation and/or receive feedback on teaching and was offered an opportunity to give input in this process.

________________________________________________

^Reviewee Faculty Name, ^Department