Name of resident:          

Name of rotation:          

Month / year of rotation:

On a scale of 1 to 10 (1=not good to 10 =excellent please score below)

For  both electives and floors/units

Material covered was relevant       Select one 1 (not good) 2 3 4 5 6 7 8 9 10 (excellent)

Teaching methods                         Select one 1 (not good) 2 3 4 5 6 7 8 9 10 (excellent)

Rounds with attendings                  Select one 1 (not good) 2 3 4 5 6 7 8 9 10 (excellent)

Time allowed to read and research Select one 1 (not good) 2 3 4 5 6 7 8 9 10 (excellent)

Percentage of time I was able to attend conferances (noon and morning report)                                         % 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%  

For floors / units only

Average number of admissions while on call # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 >15

Average daily census for intern                   # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 >15

Number of Attending rounds per week         # 0 1 2 3