Professional Documents
Culture Documents
Mentor/Preceptor (FACULTY OR PGY2/FELLOW): HAYLEY KRUSHINSKI TIME PERIOD OF LEARNING EXPERIENCE: WEDNESDAYS 2:25-5 PM
▪ This form documents resident/fellow attainment towards goal areas formally taught during the learning experience.
▪ Residents/fellows (self-evaluation) will provide commentary for each objective in the evaluation, which is based on current performance level and reflects the
aggregate resident/fellow activity during the rotation. Teaching mentor will provide verbal and written commentary following the self-evaluation.
▪ Evaluation of goal mastery is based on combined preceptor and resident/fellow judgment of resident/fellow performance on the associated objectives listed
below each goal. A check mark in the achieved column reflects goal mastery.
▪ Prior to the assigned date, complete the self-evaluation portion of each goal in relation to your participation as a conference preceptor/lab instructor. Be
prepared to review this with your assigned teaching mentor (i.e., the course coordinator/director and/or your residency/fellowship program director).