Student Progress Report - Tutorials in GS

TUTORIALS IN GENERAL SURGERY

Student Progress Report

19 ___ - 19 ___

Name ________________________________ Year Level ___ Semester ___

Faculty or Course Coordinator ___________________________________

Faculty Adviser _________________________________________________

Others __________________________________________________________

This evaluation form is to be accomplished

1. At the end of each course by a course coordinator.

2. At the end of each semester or year by a faculty adviser.

This evaluation form may be used by

- the student as a guide and for self-evaluation.

- any faculty as a guide to constantly observe, monitor, and

assess any student.

This evaluation form will be used throughout the Tutorials in

General Surgery.

Student Progress Report

Name ________________________________ Year Level ___ Semester ___

I. COMPETENCIES

Rating Scale

[Use (x) - pre-/previous and

(0) - post-/present evaluation]

Where I - Incompetent

C - Competent

1. Solver of community health problem I----+----|----+----C

2. Physician-general surgeon I----+----|----+----C

2.1 Rapport I----+----+----+----C

2.1 Clinical Diagnosis I----+----|----+----C

2.2 Paraclinical Diagnosis I----+----|----+----C

2.3 Treatment I----+----|----+----C

2.4 Advice I----+----|----+----C

3. Emergency medicine-surgery I----+----|----+----C

4. Self-directed learner I----+----|----+----C

5. Educator I----+----|----+----C

6. Researcher I----+----|----+----C

7. Administrator of a health care unit I----+----|----+----C

8. Manager I----+----|----+----C

9. Board Passer I----+----|----+----C

Overall Assessment for (I):

Note: One failure is automatically FAIL. If FAIL, justify.

E - Excellent - Progressing

S - Satisfactory - Progress maintained

NI - Needs improvement - No progress

F - Fail - Backsliding

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Student Progress Report

Name ________________________________ Year Level ___ Semester ___

II. SKILLS

Assessment Remarks

(E, S, NI, F)

1. Interpersonal __________ ________________

2. Communication __________ ________________

2.1 Oral __________ ________________

2.2 Written __________ ________________

2.3 Handwriting __________ ________________

3. Critical thinking/analysis __________ ________________

4. Decision-making/problem solving__________ ________________

5. Technical __________ ________________

6. Group learning __________ ________________

7. Referral __________ ________________

8. Others _____________________ __________ ________________

Overall Assessment for (II):

Note: One failure is automatically FAIL. If FAIL, justify.

E - Excellent

S - Satisfactory

NI - Needs improvement

F - Fail

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Student Progress Report

Name ________________________________ Year Level ___ Semester ___

III. ATTITUDE/TRAIT/PERSONALITY

Evaluation Remarks

(A, O, S, NI)

(A - Always; O - Often; S - Seldom; NI - Needs improvement)

1. Community-oriented __________ ________________

2. Teamwork __________ ________________

3. Compassionate/concern __________ ________________

4. Responsible __________ ________________

5. Hardworking/eager to learn __________ ________________

6. Resourceful/innovative __________ ________________

7. Humble/accept limitation __________ ________________

8. Role model __________ ________________

9. Good health habits __________ ________________

10. Show respect to human life __________ ________________

11. Show respect to colleagues __________ ________________

12. Show respect to authority __________ ________________

13. Others _____________________ __________ ________________

Overall Assessment for (III):

Note: If FAIL, justify.

E - Excellent

S - Satisfactory

NI - Needs improvement

F - Fail

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Student Progress Report

Name ________________________________ Year Level ___ Semester ___

IV. DISCIPLINE

No. Remarks

1. Absences in class ___ ________________________

2. Tardiness in class ___ ________________________

3. No/late reports ___ ________________________

4. Critical incident reports ___ ________________________

(Describe/incorporate)

5. Others _____________________ ___ ________________________

Overall Assessment for (IV):

Note: If FAIL, justify.

E - Excellent

S - Satisfactory

NI - Needs improvement

F - Fail

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Student Progress Report

Name ________________________________ Year Level ___ Semester ___

V. ACADEMIC PERFORMANCE

Course/Module Assessment

No. Title (E, S, NI, F)

1. ___ _________________________________________ ___________

2. ___ _________________________________________ ___________

3. ___ _________________________________________ ___________

4. ___ _________________________________________ ___________

5. ___ _________________________________________ ___________

6. ___ _________________________________________ ___________

7. ___ _________________________________________ ___________

8. ___ _________________________________________ ___________

9. ___ _________________________________________ ___________

10. ___ _________________________________________ ___________

Overall Assessment for V:

Note: One failure is automatically FAIL. If FAIL, justify.

E - Excellent - Outstanding achievement of all

objectives.

S - Satisfactory - Achievement of all objectives.

NI - Needs improvement - Unsatisfactory achievement of some

objectives; incomplete achievement

of objectives.

F - Fail - No objective achieved;

unsatisfactory despite remedials.

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Student Progress Report

Name ________________________________ Year Level ___ Semester ___

SUMMARY:

I - E S NI F

II - E S NI F

III - E S NI F

IV - E S NI F

V - E S NI F

DECISION:

Note: One failure is automatically FAIL.

( ) Needs remedials

( ) Needs improvement

( ) Eligible for promotion to ______________________________

( ) Not eligible for promotion

Remarks:

Printed Name with Signature: ___________________________

Evaluator

Date: ___________________________

Noted By:

_______________________________________

Program Director

_______________________________________

Chairman

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