PCP OBE-CBTP RTP-ACC Form # 9 2019

PCP OBE-CBTP IN INTERNAL MEDICINE

SELF ASSESSMENT FOR MEDICAL RESIDENTS

NAME _________________________________ Date accomplished: ____________

Area of rotation________________________ or YL (annual)__________

Inclusive dates:________________________

Directions: Below are set of questions that will help you assess your performance as a medical
resident. A range of numbers (from 1 to 5) will follow each statement. Encircle the number
corresponding to your response as follows:

5 – Always; 4 – Usually; 3 – Neutral; 2 – Sometimes; 1 – Never

By providing us your feedback, you are helping us assess your portfolio that aims to evaluate
professional and personal goals, achievements and methods of achieving set goals.

A. Knowledge and Skills

1. Do I generate comprehensive medical histories and PE of all 1 2 3 4 5
patients I encounter?
2. Am I able to formulate the most likely diagnoses and consider 1 2 3 4 5
other differential diagnoses of patients I encounter?
3. Am I able to plan, carry out and interpret cost effective 1 2 3 4 5
diagnostic tests for my patients?
4. Am I able to formulate cost effective and appropriate 1 2 3 4 5
management plan for my patients?
5. Am I able to manage my patients competently? 1 2 3 4 5
6. Have I developed the confidence to perform the skills 1 2 3 4 5
mandatory for my year-level competency?
7. Do I read related topics on the cases I encounter? 1 2 3 4 5
8. Can I accurately and critically appraise various medical 1 2 3 4 5
journals?
9. Do I have sufficient knowledge to understand and analyze 1 2 3 4 5
related researches that I have read?
10. Am I able to share and communicate issues about my patients 1 2 3 4 5
to other medical staff?
B. Attitude and Behavior
1. Do I have harmonious and well-balanced relationship with my:
a. Peers 1 2 3 4 5
b. Consultants 1 2 3 4 5
c. Hospital staff 1 2 3 4 5
d. Patients and family 1 2 3 4 5
2. Do I finish assigned tasks on time? 1 2 3 4 5
3. Do I report to the hospital and all other activities on time? 1 2 3 4 5
4. Am I able to handle and accept criticisms well? 1 2 3 4 5
5. Am I able to handle difficult and demanding patients? 1 2 3 4 5
6. Do I show empathy and compassion to my patients and their 1 2 3 4 5
significant others?
7. Do I honestly and correctly impart information to my 1 2 3 4 5
consultants, seniors and peers?
C. Self-Directed Learning
1. Do I devote at least 2 hours a day of reading Harrisons? 1 2 3 4 5
2. Do I search for answers (medical books, journals, web, etc.) to 1 2 3 4 5
vague issues that come to my mind during encounters with my

1
 patients?
3. Do I attend PCP supported learning activities? 1 2 3 4 5
4. Do I listen and participate in conferences I attended? 1 2 3 4 5
5. Do I research on new guidelines / updates and apply them to 1 2 3 4 5
my patients?
6. Do I engage in scholarly discussions with my peers and 1 2 3 4 5
consultants?
7. Do I apply the steps in problem solving when called for? 1 2 3 4 5
8. Do I link past and present experiences, and formulate concept 1 2 3 4 5
maps in my studies and case presentations?
9. Do I spend time in writing reflection papers regarding my daily 1 2 3 4 5
actions and decisions and after special conferences?
D. Professionalism
1. Appearance:
a. Do I dress appropriately on different occasions? 1 2 3 4 5
b. Do I wear clean smock/gown all the time? 1 2 3 4 5
2. Proper demeanor:
a. Am I polite, soft-spoken and confident when talking to my 1 2 3 4 5
patients?
b. Do I greet and introduce myself to my patients? 1 2 3 4 5
3. Punctuality:
a. Do I submit requirements and reports on time? 1 2 3 4 5
b. Am I prompt in answering referrals and follow up of lab / 1 2 3 4 5
procedure results?
c. Do I come to work and attend hospital conferences on 1 2 3 4 5
time?
4. Dependability:
a. Do I perform my duties with minimum supervision? 1 2 3 4 5
b. Do I finish required tasks before endorsing patients’ care to 1 2 3 4 5
my co-residents?
5. Respectfulness:
a. Do I observe patient confidentiality? 1 2 3 4 5
b. Do I have appropriate interpersonal relationship with my 1 2 3 4 5
peers, superiors and other hospital staff?
6. Integrity
a. Do I treat my patients in the same manner regardless of 1 2 3 4 5
social status, age, sex, religion and race?
b. Am I honest in my dealings with patients, superiors and 1 2 3 4 5
other professionals?
c. Do I make clinical judgements without the influence of the 1 2 3 4 5
pharmaceutical industries?
Use back sheet for feedback if necessary.
How do you sum-up your performance as a medical resident for this area of rotation or year level
training? Compare your performance with other rotations or previous year level.
______________________________________________________________________________
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How else do you think you can improve as a medical resident?

______________________________________________________________________________
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Feedback of discussion with training core faculty_______________________________________

______________________________________________________________________________
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____________________________ _________________________________
Your name / Signature / Date Training Core Faculty Name/Signature / Date