Evaluation forms

Reporting Milestones

Below is a list of evaluations that are filled out either by fellows or by faculty members, learners, patients, peers or allied health professionals during the fellowship year.  The fellow shall be notified within a reasonable time if an evaluation indicates unsatisfactory performance.

A one-on-one meeting between each fellow and the fellowship director will occur mid and end of year to review all fellows’ evaluations and identify strengths, weakness, goals and methods for improvement. A summary of those meetings will also be included for the fellows' records.

We have designed a checklist of required evaluations that are for you to collect throughout the year. The evaluations listed on this checklist are for you to keep track of.

Evaluation Checklist

Evaluation of Fellow Performance

Evaluation of Rotation

Evaluation of Teaching Activities

Evaluation in and of Continuity Clinics

Allied Health Professional Evaluation

Peer Evaluation Rotation Sign Out

Patient Satisfaction Form

Fellow Self-Assessment Form

Journal Club Self-Assessment Form

Lectures Evaluations (e.g. Thursday lecture, journal clubs, PM&R, community lecture)

Assessment Tools- Mini CEXs (below are individual CEXs and how many you should have done)

  • Cognition
  • Functional
  • Gait and Falls
  • Mood
(3 x per year October, February, May)
  • Family Meeting
(anytime you have a family meeting while on either Palli, UCLA NH, GEM)
(usually done during HBPC and GEM)
  • Communication with PCPs

(done on the Harbor rotation)