Residents' Postrotation Self-Evaluation

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

Surgical Trainee's Self-Evaluation Form

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

Title :

After my GSI rotation, how I will grade myself
in terms of competency expected at my level of training?

Key:

A

Adequate, Acceptable

I

Inadequate, Insufficient, Improvement Needed

NA

Not applicable, Not assessed

1. Head and Neck outside of Thyroid						AINA
2. Thyroid						AINA
3. Breast						AINA
4. Esophagus						AINA
5. Skin and Soft Tissue						AINA
6. Appendicitis						AINA
7. Hernia						AINA
8. Case Presentation and Discussion						AINA
9. Morbidity and Mortality Analysis						AINA
10. Evidence-based Medicine						AINA
11. Diagnostic Skills						AINA
12. Operative Management						AINA
13. Preop and Postop Care						AINA

How much did you learn in this course?

Quantify your entry or baseline competency.

0

25%

50%

75%

100%

Overall grade you think you deserve:

1

1.5

2

2.5

3

4

5

Excellent

Pass

Conditional

Fail

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

1	1.5	2	2.5	3	4	5
Excellent				Pass	Conditional	Fail