Radiation Oncology Oral Competency Evaluation Form

Faculty/Service:______Date:______

Resident:______Duration (circle): 30m 1hr

Case #1 Diagnosis:

Satisfactory Unsatisfactory

Workup: [ ] [ ]

Treatment: [ ] [ ]

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Comments:

Case #2 Diagnosis:

Satisfactory Unsatisfactory

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Treatment: [ ] [ ]

Knowledge: [ ] [ ]

Comments:

Case #3 Diagnosis:

Satisfactory Unsatisfactory

Workup: [ ] [ ]

Treatment: [ ] [ ]

Knowledge: [ ] [ ]

Comments:

Case #4 Diagnosis:

Satisfactory Unsatisfactory

Workup: [ ] [ ]

Treatment: [ ] [ ]

Knowledge: [ ] [ ]

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Case #5 Diagnosis:

Satisfactory Unsatisfactory

Workup: [ ] [ ]

Treatment: [ ] [ ]

Knowledge: [ ] [ ]

Comments:

FINAL ASSESSMENT (circle):

1 Exceeds expectations for PGY level

2 Meets expectations for PGY level

3 Falls below expectations for PGY level