Midwest Fellowship End of Year Performance Survey

Please answer the following questions about _____________, a current fellow in the Midwest Fellowship in Palliative Medicine. Your responses will be kept in the strictest confidence. Thank you.

Name


A red asterisk (*) indicates required questions.


  1. How well prepared was the fellow to provide care under supervision for your specialty?*
    Inadequate
    Adequate
    Good
    Very Good
    Excellent


  1. Preparation in procedural skills, namely the family conference?*
    Inadequate
    Adequate
    Good
    Very Good
    Excellent


  1. Please choose the fellow's over all preparation in the following General Competencies.

    Patient Care*
    Inadequate
    Adequate
    Good
    Very Good
    Excellent


  1. Please choose the fellow's over all preparation in the following General Competencies.

    Medical Knowledge*
    Inadequate
    Adequate
    Good
    Very Good
    Excellent


  1. Please choose the fellow's over all preparation in the following General Competencies.

    Professionalism*
    Inadequate
    Adequate
    Good
    Very Good
    Excellent


  1. Please choose the fellow's over all preparation in the following General Competencies.

    Systems Based Medicine*
    Inadequate
    Adequate
    Good
    Very Good
    Excellent


  1. Please choose the fellow's over all preparation in the following General Competencies.

    Interpersonal and Communication Skills*
    Inadequate
    Adequate
    Good
    Very Good
    Excellent


  1. Please choose the fellow's over all preparation in the following General Competencies.

    Practice Based Learning and Improvement*
    Inadequate
    Adequate
    Good
    Very Good
    Excellent


  1. This Fellow is prepared for future fellowship or fellowship training.
    Strongly Disagree
    Disagree
    Agree
    Strongly Agree


  1. This fellow is prepared to work competently and independently in the field of Hospice and Palliative Care Medicine.
    Strongly Disagree
    Disagree
    Agree
    Strongly Agree





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