DEPARTMENT OF PEDIATRICS



DEPARTMENT OF PEDIATRICS | |

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|Mission |

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|Improving the lives of children through excellence in advocacy, education, research and clinical care |

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|FACULTY PERFORMANCE AND GOALS |

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|The purpose of the faculty performance appraisal system is to link the appraisal process to your goals and to the goals and missions of the University, |

|Department, and Division, and to facilitate communication between the Division Chief and the faculty member. This form will provide a framework for your dialogue|

|with your Division Chief. This document is not intended to be used beyond these meetings. |

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|For the period of |

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|Today's Date: | |

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|Faculty General Information |

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|Name: | |

|Division: | |

|% FTE in Division: | |

|Rank and Track: | |

|Employment Date: | |

|Years in Rank: | |

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|Please enter the percentage of time spent in the following activities: |

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|Education | % |

|Scholarship | % |

|Clinical Care | % |

|Administration | % |

|Other | % |

|Total | 100 % |

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|Clinical Care |

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|Describe your clinical activities and indicate an overall rating of Exceeds Expectation, Meets Expectation, or Opportunity for Improvement. Consider the |

|following activities: inpatient and outpatient service, efforts to enhance clinical care, patient/parent comments, and clinical honors and awards. |

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|Overall Rating |

|Self-Evaluation |Division Chief Evaluation |

|Exceeds Expectation |Meets Expectation |Opportunity |Exceeds Expectation |Meets Expectation |Opportunity |

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| | |Improvement | | |Improvement |

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|Clinical responsibilities in the previous year: (Attach additional sheet, if necessary) |

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|Clinical goals for this year: |

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|Division Chief comments: |

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|Education |

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|Describe your education activities and indicate an overall rating of Exceeds Expectation, Meets Expectation, or Opportunity for Improvement. Consider the |

|following activities: medical lectures per clerkship, resident lecture series per resident year, Grand Rounds presentations, teaching honors and awards, small |

|group leadership, post-graduate education (CME lectures, etc.), curriculum development, graduate student training, laboratory training for post-doctoral fellows |

|and visiting scientists, and invited lecturer or visiting professor. |

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|Overall Rating |

|Self-Evaluation |Division Chief Evaluation |

|Exceeds Expectation |Meets Expectation |Opportunity |Exceeds Expectation |Meets Expectation |Opportunity |

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| | |Improvement | | |Improvement |

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|Education contributions in the previous year: (Attach additional sheet, if necessary) |

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|Education goals for this year: |

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|Division Chief comments: |

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|Scholarship |

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|Describe your scholarship activities and indicate an overall rating of Exceeds Expectation, Meets Expectation, or Opportunity for Improvement. Consider the |

|following activities: |

|A. Publications (list and attach copies): |C. Grants and Contracts (list) |

| Journal articles published during the last academic year | In development (what is planned, what is planned submission date) |

| Abstracts accepted for presentation | Submitted |

| Medical books and chapters | Unfunded (include score) |

|B. Presentations (list topic, what meeting, when, and where) | Funded (include score and budget) |

| Oral and poster presentations at national/ international meetings |D. Research honors and awards |

| Oral and poster presentations at regional meetings | |

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|Overall Rating |

|Self-Evaluation |Division Chief Evaluation |

|Exceeds Expectation |Meets Expectation |Opportunity |Exceeds Expectation |Meets Expectation |Opportunity |

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| | |Improvement | | |Improvement |

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|Scholarship accomplishments in the previous year: (Attach additional sheet, if necessary) |

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|Scholarship goals for this year: |

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|Division Chief comments: |

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|Administration |

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|Describe your administrative activities and indicate an overall rating of Exceeds Expectation, Meets Expectation, or Opportunity for Improvement. Consider |

|activities in the following arenas: medical school, hospital, department, other university service, community, service honors and awards, and professional |

|societies. |

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|Overall Rating |

|Self-Evaluation |Division Chief Evaluation |

|Exceeds Expectation |Meets Expectation |Opportunity |Exceeds Expectation |Meets Expectation |Opportunity |

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| | |Improvement | | |Improvement |

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|Administrative responsibilities in the previous year: (Attach additional sheet, if necessary) |

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|Administrative goals for this year: |

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|Division Chief comments: |

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|General Effectiveness as a Faculty Member |

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|Indicate rating of Exceeds Expectation, Meets Expectation, or Opportunity for Improvement for each category. |

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| |Self-Evaluation |Division Chief Evaluation |

| |Exceeds |Meets |Opportunity for |Exceeds |Meets |Opportunity for |

| |Expectation |Expectation |Improvement |Expectation |Expectation |Improvement |

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|Adaptability |

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|How well do you adjust to change? Consider your ability to | | |

|learn quickly, adapt to changes in job assignments, methods/ | | |

|processes, personnel, or surroundings. | | |

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|Dependability |

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|How reliable are you? Consider your willingness to take on | | |

|responsibilities and to be accountable for them. | | |

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|Initiative and Resourcefulness |

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|Do you see things to be done and then take action? Consider | | |

|your ability to contribute, develop, and/or carry out new | | |

|ideas or methods/processes. Consider also your ability to be a| | |

|self-starter, to offer suggestions, to anticipate needs, and | | |

|to seek additional tasks as time permits. | | |

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|Interpersonal Relationships |

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|Do you work effectively with others (superiors, peers, | | |

|subordinates)? Consider respect and courtesy shown to others, | | |

|the willingness to provide and accept guidance in a | | |

|constructive manner, how your attitude affects the work area, | | |

|and how it reflects on the division as well as your own | | |

|position. Are apparel, manners, and sociability appropriate to| | |

|the job responsibilities? | | |

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|General Effectiveness as a Faculty Member |

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|Indicate rating of Exceeds Expectation, Meets Expectation, or Opportunity for Improvement for each category. |

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| |Self-Evaluation |Division Chief Evaluation |

| |Exceeds |Meets |Opportunity for |Exceeds |Meets |Opportunity for |

| |Expectation |Expectation |Improvement |Expectation |Expectation |Improvement |

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|Judgment |

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|Do you exhibit good judgment? Consider the ability to evaluate| | |

|facts and make sound decisions and use of reasoning to | | |

|identify, solve, and prevent problems. (Not just related to | | |

|clinical activities.) | | |

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|Quality of Work |

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|How accurate, complete, and timely is your work. | | |

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|Originality/Creativity |

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|Do you see alternative solutions to problems? Do you pose new| | |

|ideas or novel concepts for consideration? | | |

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|Overall |

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|Are you an effective faculty member? Do you consider yourself | | |

|a role model for other faculty and trainees? | | |

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|Professional activities in which you wish to spend…. |

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|More time: |

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|Less time: |

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|Your plans for faculty development: |

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|Division Chief summary: |

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|Signatures |

|Faculty |Date: |

|Division Chief |Date: |

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