Division of Geriatric Medicine
Department of Internal Medicine
University of South Florida College of Medicine
ARNP Geriatric Fellow Evaluation
*
1. Fellow Name
*
2. Person Completing Survey:
*
3. Time Period
4. Activity
Bay Pines
Clinic @ USF
JAHVA-NHCU
Nursing Home
TGH
Other:
*
5. Patient Care
*
Excellent
Very Good
Good
Needs Improvement
Poor
1. Appreciates patient needs in multiple dimensions
2. Discusses treatment plan with patients/caregivers
3. Educates patients and families as appropriate
4. Displays compassion
5. Displays professionalism
*
6. Collaborative Practice
*
Excellent
Very Good
Good
Needs Improvement
Poor
1. Communicates well to team members
2. Assumes responsibility for problems beyond the scope of practice of the ARNP, documents and followup
3. Assumes responsibility for unstable patients (including documentation and followup)
4. Is accessible and prompt
*
7. Professionalism
*
Excellent
Very Good
Good
Needs Improvement
Poor
1. Takes initiative toward the smooth operation of the unit
2. Treats the staff with courtesy and respect
3. Is dependable
4. Is on time
8. Please add any additional comments.