The importance of an accurate and honest

Observership Program evaluation

The program that your international medical graduate (IMG) observer has just completed will affect
his/her career in many ways. Being able to function within the U.S. health care system and observing the
delivery of care firsthand are invaluable experiences, but there are additional benefits tied to the quality of
the evaluation you deliver.

A thoughtful and honest evaluation can provide valuable feedback to the observer with respect to how his
or her performance has been perceived. This will allow the observer to work on any areas of weakness or
deficiency in a focused manner. Ideally, the observer should have received a brief formative evaluation
midway through the observership in order to address such issues before receiving this final summative
evaluation. At that time, they also should have been given a copy of this evaluation form to understand
how and in what areas they will be evaluated.

This evaluation can also provide program directors with critical information to help them narrow the large
field of applicants they consider each year. For the Observership Program to have value and contribute
meaningfully to the process of helping IMGs obtain positions in U.S. residency programs, however,
evaluations must be accurate and not inflated. Therefore, it’s important to take a few moments after the
weeks of hard work you and your assigned observer have completed, to provide an honest review that
will serve these purposes.

The list of knowledge and skills to be evaluated may look overwhelming at first but by working through
each one and using the examples of behavior, this evaluation should be completed in five to 10 minutes.

Thank you for taking the time to complete a fair and honest evaluation.
Completing the Observership Program evaluation form

1. Familiarize yourself with the descriptions of the Overall levels of performance (below):
2. When reviewing each item, first determine if it is relevant to the observer’s experience and/or if there was
sufficient observation to evaluate. If not, check the “NA/NO” box (meaning “not applicable” or “not observed”)
and move to the next item.
3. For each item that is determined applicable to your observer and for which there was adequate observation to
evaluate, read the examples under the Needs improvement, Acceptable and Strong levels of performance.
Determine which of those three levels best describes the IMG observer.
4. Within the level you’ve selected, check one of the three numbered boxes (the higher the number, the higher your
evaluation). Check only one box for each area being evaluated.
5. Include written comments when possible, especially if the observer is rated very high or very low for an item.
6. Include any general comments or observations in the space provided at the end of the form.
7. You may choose to review the completed form with the IMG observer to provide more detailed feedback.
8. Return the form to: _______________________________________________________________________.

Overall levels of knowledge, skills or professional attributes

Needs improvement Acceptable Strong

May encounter problems in achieving Has or can be expected to achieve Already demonstrates performance at
required performance levels required performance levels or above required performance levels
 Observership evaluation

Observer name __________________________________________________________________________

Preceptor name __________________________________________________________________________

Nature of Observership (internal medicine, surgery, pediatrics, etc.)

________________________________________________________________________________________

Dates of Observership ____/_____/_____ to ____/_____/______

Institution(s) where Observership occurred

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Evaluation based on:

______ Personal observations

______ Additional input from

________________________________________________________________________________________

________________________________________________________________________________________

Evaluation submitted (date) _____/_____/_______

 Knowledge and skills
Page 1 of 4

Needs improvement Acceptable Strong

Knowledge – Significant deficits in knowledge of Working knowledge of relevant Solid grasp of relevant anatomy and
relevant anatomy and physiology; anatomy and physiology; adequate physiology; demonstrates evidence of
basic medical trouble recalling or applying principles recall of basic principles of clinically regular application of principles of all
science of basic sciences in clinical settings. relevant basic sciences basic sciences to clinically relevant
situations
NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Knowledge – Lacks basic understanding of principles Good grasp of principles of clinical Clear understanding of clinical
of clinical medicine including basic medicine despite some gaps medical principles, consistently able to
clinical science pathophysiology and therapeutics consistent with limited experience or articulate pathophysiology and relate
level of training to logical diagnostics and therapeutics
NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Knowledge – Familiarity with standard textbook and Is familiar with standard textbooks Well versed and familiar with all
references is incomplete; difficulty and references, can access medical components of medical literature
medical education accessing medical literature and literature both in library and including standard texts, references
resources searching and retrieving relevant electronically; can search and and peer-reviewed journals; searches
information; interpretation of study retrieve relevant information; can are focused and efficient and
results often flawed interpret results of studies consistently retrieve relevant
information; critically appraises results
of studies
NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Knowledge – Often appears confused by elements of Demonstrates basic understanding Demonstrates clear understanding of
US Healthcare system, has trouble of the US Healthcare system, able to the US Healthcare system, able to
health care integrating new elements even with a integrate new elements with effectively relate components
system appropriate explanation, may be appropriate explanation, comfortable including those less frequently
unaware of significant components; with most commonly encountered encountered; demonstrates and
oblivious to or confused by health care elements; basic appreciation of expresses awareness of implications
financing system implications of health care financing of health care financing system
system
NA/NO
1 2 3 4 5 6 7 8 9
Comments:
 Knowledge and skills
Page 2 of 4

Knowledge – Often appears confused by names, Can apply basic knowledge of clinical Demonstrates sound knowledge of
dosages and indications for commonly pharmacology to identifying names, dosages and indications of all
U.S. formulary used drugs in U.S. formulary; appropriate drugs in U.S. formularies commonly used drugs in U.S.
frequently using names of drugs from that may differ in name, dosages or formulary with no evidence of
prior education or practice setting; little indications from those in their prior confusion with drugs used previously;
or no familiarity with pharmacological country of training or practice; some facility with using pharmacological
references. familiarity with pharmacological references
references..
NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Needs improvement Acceptable Strong

Skills – clinical Beginning with specifics not related to
CC or HPI; makes no effort to clarify
skills – medical unintelligible or inadequate answers;
history reasonable associations of symptoms
not pursued; ignores obvious risk
factors; pursues low yield information
or fails to pursue critical information;
random questions in no logical order
NA/NO
1 2 3 4
Comments:
Starts with specifics but those
identified in CC or HPI; reposes
questions to inadequate answers;
broad pursuit of potential related
symptoms but not necessarily specific
to case; generally explores common
risk factors; follows up on most
important information; questions in
some order and lead from general to
specific
5 6
Initially broad inquiries followed by
specifics as indicated by CC and
HPI; rephrases patient responses or
offers similes to clarify inadequate
answers; sequential questioning of
associated symptoms and pursuit of
associations which may not be
intuitive; thoroughly explores all risk
factors; selective use of followup
questions with deeper probing of
critical information; clearly organized
pattern of questions from general to
specific
7 8 9

Communication – May express impatience with Makes efforts to understand and be Consistently confirms that
difficulties in understanding or being understood; rarely uses medical understanding is clear by repetition,
patients and understood; may use medical jargon jargon; generally respectful in soliciting questions; explains any
families without explanation; may convey addressing; is open to diverse beliefs medical terminology used; always
disdain toward some; critical of beliefs and attitudes toward health respectful in addressing; genuine
or attitudes that do not conform to own effort to understand and respect
diverse beliefs and attitudes
NA/NO
1 2 3 4 5 6 7 8 9
Comments:
 Knowledge and skills
Page 3 of 4

Communication – May be overly deferential toward
superiors and/or dismissive of peers;
colleagues conversations and discussions may be
minimal and often tangential or
inappropriate; may be evasive when
questioned; resistant to new ideas and
approaches
NA/NO
1 2 3 4
Comments:
Respectful of superiors and peers;
conversations and discussions are
generally relevant and appropriate,
answers questions forthrightly, open
to diverse ideas and approaches,
5 6
Treats all colleagues respectfully
whether superiors or peers; actively
participates in conversations and
discussions without trying to
dominate or show off; welcomes
questions and challenges; actively
solicits different points of view and
rationales
7 8 9

Communication – Shows little interest in understanding
role and expertise of staff; rarely if ever
nursing and approaches staff for help or
ancillary staff information and may ignore or dismiss
suggestions when made; may be
disrespectful or make disparaging
remarks about staff; quick to blame
staff for lack of knowledge or
performance
NA/NO
1 2 3 4
Comments:
Acknowledges role and expertise of
staff and accepts suggestions; may
occasionally approach staff for help or
information; treats staff with respect;
rarely criticizes or blames staff for lack
of knowledge or performance
5 6
Makes efforts to learn the role and
expertise of staff; actively solicits staff
information and help and takes
suggestions gracefully; treats staff
respectfully as colleagues; often
compliments staff on knowledge and
skills
7 8 9

Clinical skills – Frequent problems with Generally comprehensible, accent Virtually no difficulty in
comprehension and understanding due may be obvious but not problematic, comprehension even if accent is
communication - to rate of speech, extreme accent or makes effort to adapt rate of speech present, confirms understanding of
spoken English errors in syntax, little or no effort to and pronunciation to listener, may listener by repetition or clarification as
proficiency adapt to listeners or clarify, may attempt to incorporate idioms although necessary, reasonable facility with
become annoyed or upset when not always successful incorporation of idioms
misunderstood
NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Clinical skills – Handwritten entries frequently illegible, Handwritten entries are legible, Handwriting consistently legible with
spelling and syntax errors hamper occasional spelling and syntax errors; accurate spelling and syntax;
communication – comprehensibility; entry by keyboard may be slow and proficient at typing with few errors
written essentially unable to enter material via error prone but final drafts are and final proof near perfect
keyboard or does so with multiple reasonably proofed
unproofed errors
NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Skills – Has recurrent difficulty accessing Is able to access electronic medical Easily and efficiently accesses and
electronic medical records; often records and locate relevant moves about within electronic
information unable to locate relevant information; information; is able to appropriately medical records to locate and retrieve
technology skills unable to enter clinical information or enter basic clinical information into information and to enter information
– electronic does so with frequent errors of format electronic medical records in appropriate locations and formats
medical records or location.
NA/NO
1 2 3 4 5 6 7 8 9
Comments:
 Knowledge and skills
Page 4 of 4

Needs improvement Acceptable Strong

Skills – IT skills – Frequently unable to retrieve current Can generally retrieve current Facility with retrieving not only
laboratory results or radiology reports laboratory results and radiology current laboratory results and
information or retrieves erroneous information, e.g., reports radiology reports but also with
retrieval – clinical wrong patient accessing older and archived
data materials
NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Skills – IT skills – Has difficulty accessing electronic and Can retrieve necessary information Facility with retrieving key
web-based resources, frequently from electronic and web-based information from electronic and web-
information unable to retrieve necessary resources; can construct and carry out based resources, frequently in real-
retrieval – information; unfamiliar with or unable to reasonable searches using PubMed or time and at point of service; uses
reference effectively use search engines other search engines PubMed or other search engines to
material conduct efficient, comprehensive
searches
NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Skills – Presentation of patients is Presents patients following traditional Presents patients following clear and
disorganized with significant relevant format, includes relevant information logical format, relevant information
presentation information lacking; results of and results of diagnostics; responds includes pertinent positives and
skills – patient diagnostics not presented or presented appropriately to questions negatives; results of diagnostic tests
presentations in confusing or unclear manner presented with proposed
interpretations; highly receptive to
questions and comments
NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Skills – Assigned topic may be misconstrued Presents topics as assigned, includes Focuses assigned topics for maximal
or unfocused, only rudimentary material basic required information, relevance, materials beyond basics
presentation presented, no or ineffective AV presentation is logical, AV materials as appropriate, AV materials
skills – materials; unable to respond to many are appropriate; able to respond to significantly contribute to
educational questions most questions presentation; confidently takes
presentations questions and responds appropriately
NA/NO
1 2 3 4 5 6 7 8 9
Comments:
 Professional qualities
Page 1 of 4

Needs improvement Acceptable Strong

Professional May be evasive when lacking Consistently honest, does not Unswervingly honest, readily admits
information, may fabricate answers to fabricate answers if does not know, and may even volunteer when lacking
qualities – avoid embarrassment, may attempt to does not takes credit for things done information or answers, acknowledges
integrity take credit for accomplishments of by others accomplishments of others, may
others minimize credit for own
accomplishments

NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Needs improvement Acceptable Strong

Professional Frequently has or expresses negative
judgments regarding groups or types
qualities – of people, may use derogatory terms,
tolerance rejects validity of different perspectives
even when explained
Accepts people of diverse
backgrounds, does not express
negative judgments or use derogatory
terms, acknowledges validity of
differing perspectives when explained
Actively attempts to understand
perspectives and values of diverse
groups, makes efforts to maintain
sensitivity to cultural and other
interpersonal issues

NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Needs improvement Acceptable Strong

Professional Expresses resistance to or
dismissiveness regarding principles of
qualities – confidentiality, may be careless with
confidentiality patient related documents, frequently
discusses patient information in
unsecured areas
Understands and accepts principles of
confidentiality, generally careful with
patient related documents, may
occasionally reference patient
information in unsecured areas
Values and respects principles of
confidentiality, consistently
conscientious regarding patient
related documents, never discusses
patient information in unsecured areas

NA/NO
1 2 3 4 5 6 7 8 9
Comments:
 Professional qualities
Page 2 of 4

Needs improvement Acceptable Strong

Professional Frequently or persistently late for Generally on time for scheduled Always on time for scheduled
scheduled activities, considers activities, understands and accepts activities, may even make a point of
qualities – tardiness not a significant issue the importance of punctuality arriving a few minutes early, may
punctuality articulate respect for others which
punctuality bespeaks
NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Needs improvement Acceptable Strong

Professional Fails to complete tasks assigned or Generally completes tasks assigned, Consistently completes tasks assigned
requires repeated reminders and rarely needs to be reminded or on or before due dates with no need
qualities – prodding, materials delivered may be prodded, produces materials for reminders, materials produced
reliability inappropriate to requests and/or of consistent with requests and of consistently meet and often exceed
unacceptable quality acceptable quality specifications, all work is of highest
quality
NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Needs improvement Acceptable Strong

Professional Has difficulty gathering information or After adequate directions Can gather information and complete
completing tasks even after extensive subsequently is able to gather tasks after only minimal initial
qualities – directions, rarely or never initiates information or complete tasks with direction, consistently initiates
initiative proposals or offers suggestions minimal additional guidance, proposals and offers suggestions,
sometimes initiate proposals or offers seeks creative solutions to problems
suggestions
NA/NO
1 2 3 4 5 6 7 8 9
Comments:
 Professional qualities
Page 3 of 4

Needs improvement Acceptable Strong

Professional Makes minimal or no contribution to
discussions even when invited or
qualities – makes inappropriate or overly
participation aggressive attempts to dominate
discussions
Makes effort to participate in
discussions and activities although
may sometimes require some drawing
out or may occasionally tend to be
overly or inappropriately verbose
Consistently contributes meaningfully
to discussions while evidencing
respect for input of others, can
appropriately gear level of
participation to nature of discussion

NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Needs improvement Acceptable Strong

Professional Has great difficulty functioning in a
team framework, may express
qualities – significant skepticism of the team
teamwork concept or resistance to its
implementation, recurring problem with
deferring to other team
After adequate introduction, can
function appropriately within a team
framework, although may have some
confusion regarding team concept or
resistance to deferring to other team
members
A natural team player, evidences
mutual respect and support of all team
members, able to defer or lead as
appropriate, actively acknowledges
contributions of other team

NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Needs improvement Acceptable Strong

Professional May become overly defensive receive Can accept and respond to both Consistently solicits feedback both
negative feedback, tends to make negative and positive feedback negative and positive, never defensive
qualities – excuses and blame others, rarely if although may evidence minimal or blaming of others for shortcomings,
receptivity to ever actively seeks feedback defensiveness, generally only seeks actively attempts to correct problems
feedback feedback following errors or difficulties and initiates follow-up feedback

NA/NO
1 2 3 4 5 6 7 8 9
Comments:
 Professional qualities
Page 4 of 4

Needs improvement Acceptable Strong

Professional Fails to recognize limits of knowledge
and skills even when clearly exceeded,
qualities – unaware of strengths or weaknesses,
mindfulness oblivious to prejudices, and not
capable of self reflection
Can generally recognize limits of
knowledge and skills when
challenged, evidences awareness of
strengths and weaknesses and
prejudices, capable of self reflection
but generally only when asked to do
so
Accurate and realistic recognition of
limits of knowledge and skills, modestly
acknowledges strengths while actively
working on weaknesses, identifies and
resists personal prejudices, regularly
engages in self reflection

NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Needs improvement Acceptable Strong

Professional Pursuit of knowledge and skills in
medicine is often secondary to
qualities – personal issues, tends to minimize
dedication time and effort devoted to training,
long-term goals primarily self-
centered, rarely evidences genuine
concern for patients
Conscientiously pursues acquisition of
knowledge and skills in medicine,
evidences willingness to accept
personal challenges of training and
practice, evidences genuine concern
for patient's welfare
Enthusiastically seeks out
opportunities to increase knowledge
and skills in medicine, evidences
willingness to devote necessary time
and effort to training and practice but
also maintains healthy balance in
lifestyle, active and compassionate
patient advocate

NA/NO
1 2 3 4 5 6 7 8 9
Comments:

Needs improvement Acceptable Strong

Teachability / Requires frequent repetition of most
basic information, fails to apply general
Learnability principles to specific cases; resistant to
correction, defensive to negative
feedback; rarely asks questions, little
or no participation in discussions
NA/NO
1 2 3 4
Comments:
Retains new information well, can
usually apply principles to specific
cases, takes correction and negative
feedback well; asks good questions
and participates in discussions
5 6
Actively pursues knowledge and
explores topics on own initiative,
effectively applies principles to specific
cases, seeks and responds to
correction and feedback; questions
are incisive and participates actively
and appropriately in discussions
7 8 9
Overall Comments
Include any comments, observations or information that you believe would be of value to those who may be
assessing this observer as a potential program applicant.