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Example 1: Resident Reflection Self-Assessment Example of a reflective exercise for residents/fellows providing care for pediatric patients with HIV infection. This can be modified to fit with characteristics specific to the trainee’s elective site. Name of resident: Date completed: Please describe (age, gender, HIV stage, illness, and other co-morbid conditions) up to five patients you counseled about starting antiretroviral therapy.Please describe (age, gender, HIV stage, illness, and other co-morbid conditions) up to five patients you started on antiretroviral therapy, including five younger than 12 months of age if applicable.Please reflect on up to five antiretroviral adherence counseling sessions and describe what you learned from each situation.Please describe how you disclosed the diagnosis of HIV/AIDS to up to five patients older than 12 years of age.Please describe how you disclosed the diagnosis of HIV/AIDS to up to five patients younger than 12 years of age.Please describe any challenges/limitations in caring for HIV/AIDS patients due to culture, language, resources, or other reasons.Please describe how you participated in community-based education and clinical care with outreach teams. Example 2: Resident Assessment Global Health Elective Evaluation FormName of resident: Date completed: Elective start date:Elective end date: Name of evaluator: Email: Thank you for participating in the education of our residents during their elective. We would appreciate your feedback about their performance during the elective. Please complete the following form and place it in a sealed envelope with your signature over the flap to return with the resident. We would appreciate if you would provide verbal feedback to the resident when you return the form to them. If there are any questions or issues that you would rather share privately via email, please contact the elective directors (insert names). Thank you for your time!Please rate this resident’s competencies using the following numeric scale:(1 = lowest [worst] competency; 5 = highest [best] competency)Examples of the criteria for ratings of 1, 3, and 5 are provided below each scale.Patient care: Address cultural and language barriers to gather important and accurate information about the patientPerformance level of this resident (please circle one)12345Unable to assessExamples of 1, 3, and 5 rating criteria: 1: Cannot overcome cultural and language barriers, resulting in poor ability to provide effective patient care3: Overcomes barriers enough to gather some information to develop a basic differential diagnosis and management plan5: Overcomes barriers enough to gather detailed information to develop a sophisticated differential diagnosis and management planPatient care: Adapt to an unfamiliar health care system to organize and prioritize responsibilities to provide patient care that is safe, effective, and efficientPerformance level of this resident (please circle one)12345Unable to assessExamples of 1, 3, and 5 rating criteria: 1: Unable to adapt to a new health system and differing resources to provide safe, effective, and efficient patient care3: Able to occasionally adapt to a new health system and differing resources to provide safe, effective, and efficient patient care5: Consistently adapts to a new health system and differing resources to provide safe, effective, and efficient patient carePractice-based learning and improvement: Identify strengths, deficiencies, and limits in knowledge and expertise in a resource-limited settingPerformance level of this resident (please circle one)12345Unable to assessExamples of 1, 3, and 5 rating criteria: 1: Unable to manage patients with limited technology and limited access to consultants3: Able to manage most aspects of patient care with limited technology and limited access to consultants5: Able to effectively use available resources to manage all aspects of patient care with limited technology and limited access to consultantsPractice-based learning and improvement: Identify and perform appropriate learning activities to guide personal and professional development/self-improvementPerformance level of this resident (please circle one)12345Unable to assessExamples of 1, 3, and 5 rating criteria: 1: Does not seek additional resources or participate in projects for self-improvement3: Occasionally seeks some additional resources and participates in some projects for self-improvement5: Consistently seeks additional resources and participates in projects for self-improvementProfessionalism: Demonstrate humanism, compassion, integrity, and respect for patients through advocating for their well-being despite resource limitationsPerformance level of this resident (please circle one)12345Unable to assessExamples of 1, 3, and 5 rating criteria: 1: Does not advocate for patients3: Occasionally advocates for patients 5: Consistently advocates for patients Professionalism: Demonstrate a sense of duty and accountability to patients and the professionPerformance level of this resident (please circle one)12345Unable to assessExamples of 1, 3, and 5 rating criteria: 1: Was not reliable and did not collaborate to strengthen the health system3: Was occasionally reliable and occasionally collaborated in efforts to strengthen the health system5: Was very reliable and collaborated consistently to strengthen the health system Interpersonal and communication skills: Communicate effectively and respectfully with physicians, other health professionals, and health-related agencies in an unfamiliar systemPerformance level of this resident (please circle one)12345Unable to assessExamples of 1, 3, and 5 rating criteria: 1: Does not show interest in working with other health professionals or those in systems different from the trainee’s3: Communicates fairly well with some other health professionals or those in systems different from the trainee’s5: Actively interacts and communicates in a respectful way with other health professionals and those in systems different from the trainee’sInterpersonal and communication skills: Able to manage emotions in a positive way when working within a different setting during stressful situationsPerformance level of this resident (please circle one)12345Unable to assessExamples of 1, 3, and 5 rating criteria: 1: Unable to manage emotions and becomes frustrated easily during stressful situations3: Able to manage some emotions during stressful situations5: Able to effectively manage emotions and assist colleagues during stressful situationsAdditional comments: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Example 3: Note: This example is less preferable than Example #2 above but should be considered for evaluators who are not familiar with competency-based assessment tools.Resident Assessment Thank you for participating in the education of our residents during their elective. We would appreciate your feedback about their performance during the elective. Please complete the following form and place it in a sealed envelope with your signature over the flap to return with the resident. We would appreciate if you would provide verbal feedback to the resident when you return the form to them. If there are any questions or issues that you would rather share privately via email, please contact the elective directors (insert names). Thank you for your time!Elective DatesFrom:To:Resident Name:Location:Faculty Supervisor:ASSESSMENT OF RESIDENT COMPETENCIESNot observedNeeds improvementOn target/at expected levelAdvancedUnable to assessRespect for and recognition of cultural differencesUnderstanding of cultural differencesCommunication skills, including effective listeningInteractions with co-workersInteractions with clients, patients, or community membersFlexibility in cross cultural settingsReliabilityInitiativeEffectivenessGeneral knowledge of disciplineAwareness of other pertinent informationOVERALLWritten assessment of resident:Additional suggestions or comments: ................
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