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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