Peer Evaluation Form (Pef)

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Peer Evaluation Form (PEF)
R esid en t’s Name:______________________ Date:___________________
1 = Unacceptable
6 = Outstanding
NA = Not applicable /Can not access
Ability
Medical Knowledge
1
2
3
4
5
6
NA
Professional Judgment
1
2
3
4
5
6
NA
Technical skills
1
2
3
4
5
6
NA
Work Habits
Promptness
1
2
3
4
5
6
NA
Attendance
1
2
3
4
5
6
NA
Initiative
1
2
3
4
5
6
NA
Dependability
1
2
3
4
5
6
NA
Industry
1
2
3
4
5
6
NA
Work Product
Histories & Physicals
1
2
3
4
5
6
NA
Progress notes
1
2
3
4
5
6
NA
Verbal presentations
1
2
3
4
5
6
NA
Teaching Abilities
Student directed
1
2
3
4
5
6
NA
Resident directed
1
2
3
4
5
6
NA
Personal Evaluation
Appearance
1
2
3
4
5
6
NA
Emotional maturity
1
2
3
4
5
6
NA
Patient rapport & empathy
1
2
3
4
5
6
NA
Cooperation with others
1
2
3
4
5
6
NA
Leadership abilities
1
2
3
4
5
6
NA
List three attributes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
List three deficits:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Peer Evaluation Form (PEF)
R esid en t’s Name:______________________ Date:___________________
1 = Unacceptable
6 = Outstanding
NA = Not applicable /Can not access
Ability
Medical Knowledge
1
2
3
4
5
6
NA
Professional Judgment
1
2
3
4
5
6
NA
Technical skills
1
2
3
4
5
6
NA
Work Habits
Promptness
1
2
3
4
5
6
NA
Attendance
1
2
3
4
5
6
NA
Initiative
1
2
3
4
5
6
NA
Dependability
1
2
3
4
5
6
NA
Industry
1
2
3
4
5
6
NA
Work Product
Histories & Physicals
1
2
3
4
5
6
NA
Progress notes
1
2
3
4
5
6
NA
Verbal presentations
1
2
3
4
5
6
NA
Teaching Abilities
Student directed
1
2
3
4
5
6
NA
Resident directed
1
2
3
4
5
6
NA
Personal Evaluation
Appearance
1
2
3
4
5
6
NA
Emotional maturity
1
2
3
4
5
6
NA
Patient rapport & empathy
1
2
3
4
5
6
NA
Cooperation with others
1
2
3
4
5
6
NA
Leadership abilities
1
2
3
4
5
6
NA
List three attributes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
List three deficits:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

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