Student Progress Report

Name Oliver Leyson, M.D.  Year Level _III_ Date 11-28-04_

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----X+----|--+-O---C

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

    2.1 Rapport                             I----+--X--+----+--O--C

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

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

    2.3 Treatment                           I----+----X|-----O---C

    2.4 Advice                              I----+----X|-+-----O--C

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

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

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

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

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

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

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

Overall Assessment for (I): S

   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 Oliver Leyson, M.D.    Year Level _III_ Date 11-28-04_

II. SKILLS

                                   Assessment    Remarks

                                  (E, S, NI, F)

 1. Interpersonal                  _____S____    ________________

 2. Communication                  _____NI ___    ________________

     2.1 Oral                      _____NI____    ________________

     2.2 Written                   _____NI____    ________________

     2.3 Handwriting               _____S____    ________________

 3. Critical thinking/analysis     _____S____    ________________

 4. Decision-making/problem solving_____NI____    ________________

 5. Technical                      _____S____    ________________

 6. Group learning                 _____S____    ________________

 7. Referral                       _____S____    ________________

 8. Others _____________________   __________    ________________

Overall Assessment for (II): S

     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 Oliver Leyson, M.D.    Year Level _III_ Date 11-28-04_

III. ATTITUDE/TRAIT/PERSONALITY

                                   Evaluation    Remarks

                                 (A, O, S, NI)

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

 1. Community-oriented             ____A_____    ________________

 2. Teamwork                       ____A_____    ________________

 3. Compassionate/concern          ____A_____    ________________

 4. Responsible                    ____A_____    ________________

 5. Hardworking/eager to learn     ____O_____    ________________

 6. Resourceful/innovative         ____A_____    ________________

 7. Humble/accept limitation       ____A_____    ________________

 8. Role model                     ____O_____    ________________

 9. Good health habits             ____O_____    ________________

10. Show respect to human life     ____A_____    ________________

11. Show respect to colleagues     ____A_____    ________________

12. Show respect to authority      ____A_____    ________________

13. Others _____________________   __________    ________________

Overall Assessment for (III): S

     Note: If FAIL, justify.

     E - Excellent

     S - Satisfactory

    NI - Needs improvement

     F - Fail

                                3

                     Student Progress Report

Name Oliver Leyson, M.D.    Year Level _III_ Date 11-28-04_

IV. DISCIPLINE

                                   No.   Remarks

 1. Absences in work/conferences   _1__   ________________________

 2. Tardiness in work/conferences  _O__   ________________________

 3. No/late reports                _2__   ________________________

 4. Critical incident reports      _O__   ________________________

     (Describe/incorporate)

 5. Others _____________________   ____   ________________________

Overall Assessment for (IV): S

     Note: If FAIL, justify.

     E - Excellent

     S - Satisfactory

    NI - Needs improvement

     F - Fail

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Student Progress Report

Name Oliver Leyson, M.D.    Year Level _III_ Date 11-28-04_

V. ACADEMIC PERFORMANCE

    Course/Module                                    Assessment

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

 1. ___    Patient management process                NI 

 2. ___     MAR                                       NI

 3. ___    Medical Recording                         S

 4. ___     Medical Photography                       S

 5. ___     Research                                  NI

 6. ___    Surgical Curriculum                       S

 7. ___     Disaster Preparedness Program             S

 8. ___     Test contructions                         S

 9. ___     Online GS Journal                         S

10. ___     Medical presentation                      NI

Overall Assessment for V: S

     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 Oliver Leyson, M.D.    Year Level _III_ Date 11-28-04_

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:

          _______________________________________

                       Training Officer

          _______________________________________

                          Chairman

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