D R A F T - University of South Carolina



University of South Carolina School of MedicineAnnual Faculty Evaluation and Planning DocumentCalendar Year: _______________________Faculty Member: __________________________________Tenure Status: ________________________Rank: _________________________Percent Effort:Teaching __________Research/Scholarly Activity __________Service/Patient Care __________TOTAL 100%. Teaching (% Effort: )A.Specific Planned Activities for Next Year:Undergraduate StudentsMedical StudentsGraduate StudentsResidents/Fellows/Postdoctoral StudentsCME/Faculty DevelopmentOther Activities (List)B.This Year’s Current Teaching Assignments/Teaching Load Activities:Undergraduate StudentsMedical StudentsGraduate StudentsResidents/Fellows/Postdoctoral StudentsCME/Faculty DevelopmentOther Activities (List)C.Assessment of This Year’s Performance:0123NA1. Undergraduate Students2. Medical Students3. Graduate Students4. Residents/Fellows5. CME/Faculty Development6. Other Activities (List)(Note: 0=Unsatisfactory, 1=Adequate, 2=Substantial, 3=Outstanding)Summary of Student Evaluations of Teaching:(Required annually)Summary of Peer Evaluations of Teaching:(Required annually for non-tenured, tenure-track faculty)F. Overall Teaching Assessment:ments of Department Chair or Equivalent:II. Research/Scholarly Activity (% Effort: )A.Specific Planned Activities for Next Year:Current Grants/ContractsGrants/Contracts to be SubmittedRefereed PublicationsBooks/Book ChaptersPresentationsAbstracts7.Other Activities (List)This Year’s Current Research/Scholarly Activities:Current Grants/ContractsGrants/Contracts SubmittedRefereed PublicationsBooks/Book ChaptersPresentationsAbstracts7.Other Activities (List)C.Assessment of This Year’s Performance:0123NA1. Current Grants/Contracts2. Grants/Contracts Submitted3. Refereed Publications4. Books/Book Chapters5. Presentations6. Abstracts7. Other Activities (List)(Note: 0=Unsatisfactory, 1=Adequate, 2=Substantial, 3=Outstanding)D. Overall Research/Scholarly Activity Assessment:0123NAComments of Department Chair of Equivalent:III. Service/Patient Care (% Effort: )A.Specific Planned Activities for Next Year:CommitteesAdministrative ActivitiesPatient CareCitizenship (e.g., attendance at faculty meetings, Grand Rounds, etc.)Extramural Professional Service (e.g., grant reviews, editorial boards, professional associations, etc.)Other Activities (List)This Year’s Current Service/Patient Care Activities:CommitteesAdministrative ActivitiesPatient CareCitizenship (e.g., attendance at faculty meetings, Grand Rounds, etc.)Extramural Professional Service (e.g., grant reviews, editorial boards, professional associations, etc.)6.Other Activities (List)C.Assessment of This Year’s Performance:0123NA1. Committees2. Administrative Activities3. Patient Care4. Citizenship5. Extramural Professional Service6. Other Activities (List)(Note: 0=Unsatisfactory, 1=Adequate, 2=Substantial, 3=Outstanding)D. Overall Service/Patient Care Assessment:0123NAComments of Department Chair or Equivalent:SummaryA. Summary Assessment of This Year’s Performance:0123 (Note: 0=Unsatisfactory, 1=Adequate, 2=Substantial, 3=Outstanding)Summary Weighted Assessment of This Year’s Performance:% Effort x Overall Assessment(0-3)= ScoreTeachingResearch/Scholarly ActivityService/Patient CareTOTAL SCOREC.Summary Comments of Department Chair or Equivalent:D.Faculty Member’s Comments:PLANNING STAGE: ___________________________________ ____________Faculty Member Date___________________________________ ____________Department Chair or Equivalent Date___________________________________ ____________Dean or Designee DateEVALUATION: ___________________________________ ___________Faculty Member Date___________________________________ ____________Department Chair or Equivalent Date___________________________________ ____________Dean or Designee Date(Signature by the faculty member does not necessarily mean he/she agrees with the evaluation. The faculty member may append to this document a brief comment on the Evaluator’s evaluation.)Approved by the Provost on 2/16/99 ................
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