Division
of
Head and Neck, Breast, Esophagus, and Soft Tissue Surgery

(General Surgery I)

Department of Surgery

College of Medicine
Philippine General Hospital
University of the Philippines Manila

The GSI Residency Training Program

  Faculty's Evaluation of Surgical Trainee

Faculty's Name:

First Name: Surname:Email:
Date: Day in number: Month in word:Year in number:
Inclusive Dates of Rotation in GSI:

Title :

Evaluation of surgical trainee after GSI rotation
in terms of competency expected at his/her level of training

Key:
A	Adequate, Acceptable
I	Inadequate, Insufficient, Improvement Needed
NA	Not applicable, Not assessed

Overall grade trainee deserves:

1	1.5	2	2.5	3	4	5
Excellent				Pass	Conditional	Fail

Comments:

GSI Residency Training Program