University of Toronto
Department of Psychiatry

Supervisor Evaluation Form

Rotation Service :

Period :

Resident :

Teacher/Supervisor :

Hospital/Site :

Part I

On average, how many hours of regularly scheduled supervision

did you have per WEEK with this supervisor? -

How many observed (live or taped) interviews did you have with

this supervisor per SIX MONTHS? -

How many times during the rotation did your supervisor provide detailed feedback on your progress (excluding the formal 6 month evaluation)?

None

1

2

3 or more

II CAN MEDS ROLE: MEDICAL EXPERT

The Satisfactory Supervisor:

The Satisfactory Supervisor

1 – Unsatisfactory 4 - Above Expectations
2 - Below Expectations 5 - Excellent
3 - Meets Expectations N/A - Not Applicable

1 2 3 4 5 N/A

1. CLINICAL SKILLS

·  effectively teaches assessment, diagnostic and therapeutic skills for ethical and effective patient care

·  effectively teaches how to access and apply relevant information to clinical practice

·  effectively teaches how to successfully provide consultation services with respect to patient care, education

and legal opini

2. COLLABORATIVE SKILLS

·  effectively teaches how to consult successfully with other physicians and health care professionals

·  effectively teaches how to successfully contribute to interdisciplinary team activities

III CAN MEDS ROLE: SCHOLAR

The Satisfactory Supervisor:

The Satisfactory Supervisor

1 2 3 4 5 N/A

1. KNOWLEDGE

·  critically appraises sources of medical/psychiatric information

·  discusses alternate points of view and directs resident to the literature

·  keeps up-to-date with current knowledge and theories critically appraises sources of medical/psychiatric information

·  discusses alternate points of view and directs resident to the literature

·  keeps up-to-date with current knowledge and theories

2. TEACHING SKILLS

·  stimulates interest in the area

·  facilitates learning of patients, house staff/students and other health professionals

·  enjoys teaching

·  is dynamic, energetic and creative in teaching

·  stimulates interest in the area

·  facilitates learning of patients, house staff/students and other health professionals

·  enjoys teaching

·  is dynamic, energetic and creative in teaching

IV. CAN MEDS ROLE: MANAGER

The Satisfactory Supervisor:

The Satisfactory Supervisor

1 2 3 4 5 N/A

1. MANAGERIAL SKILLS

·  effectively teaches the skills necessary to work successfully and efficiently in a healthcare organization

·  effectively teaches how to use information technology to optimize patient care

·  effectively teaches how to work with a team

·  provides support and encouragement

2. RELATIONSHIP TO RESIDENT

·  helps the resident to effectively balance patient care, learning needs and outside activities

·  provides support and encouragement

·  actively encourages the resident in problem solving

·  provides supervision at a level appropriate to the resident’s level of training

·  helps the resident develop clear and appropriate goals and expectations

3. AVAILABILITY

·  is available and accessible to the resident for consultation

V. CAN MEDS ROLE: COMMUNICATOR

The Satisfactory Supervisor:

The Satisfactory Supervisor

1 2 3 4 5 N/A

1. AS A CLINICIAN

·  effectively teaches how to listen to patients, families and the healthcare team

·  effectively teaches how to present information in a clear and organized manner

·  effectively teaches how to establish a therapeutic relationship with patients/families

·  effectively teaches how to obtain and synthesize relevant history from patients/families/communities

·  effectively teaches how to discuss appropriate information concerning patients with the healthcare team

2. RELATIONSHIP TO RESIDENT

·  listens effectively to resident

·  emphasizes what is important

·  provides regular feedback with clear, constructive criticism

·  discusses appropriate information concerning patients with resident

VI. CAN MEDS ROLE: PROFFESIONAL

The Satisfactory Supervisor:

The Satisfactory Supervisor

1 2 3 4 5 N/A

1. ROLE MODEL

·  acts as an appropriate clinical and professional role model

·  acts as an appropriate role model as a teacher

·  demonstrates self-confidence, flexibility, respect and a non-dogmatic approach

·  relates to the resident as a respected colleague

·  demonstrates sensitivity to gender, ethical, cultural and socioeconomic issues

2. CLINICIAN

·  delivers high quality care with integrity, honesty and compassion

·  practices medicine ethically consistent with the obligations of a physician/heath care professional and a supervisor

3. ADVOCATE

·  identifies the important determinants of health affecting patients

·  contributes to improved heath of patients and communities

·  recognizes and responds to these issues where advocacy is appropriate

PART VII

The Satisfactory Supervisor:

The Satisfactory Supervisor

1 2 3 4 5 N/A

OVERALL I WOULD RATE THIS SUPERVISOR

Please describe your supervisor’s major SRTENGTHS as a supervisor.

Please describe your supervisor’s major WEAKNESSES as a supervisor.

Please suggest ways in which your supervisor could improve the quality of supervision.

Please describe you supervisor’s major STRENGTHS as a supervisor

Please describe your supervisor’s major WEAKNESSES as a supervisor

Please suggest ways in which your supervisor could improve the quality of supervision.

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