1. (Unsatisfactory) Superficial, inaccurate, incomplete or illogical. Fails to collect key information. Unable to screen unrelated or unimportant information. Data insufficient to support diagnosis. Major omissions.

2. (Marginal) Some omissions. Lacks supporting detail. Significant difficulty collecting relevant data consistently. May include extraneous information. Lacks precision, reliability.

3. (Satisfactory) Consistently collects relevant data with essential positives and negatives, sufficient to support diagnosis. Occasional gaps.

4. (Good) Extensive data collection. Usually accurate, complete, thorough, well organized. Often uses collateral sources. Sometimes uses rating scales or validated diagnostic instruments.

5. (Excellent/Outstanding) Efficiently, consistently collects all relevant data from multiple sources, including own reactions to patient. Well-written, succinct, focused, yet comprehensive. Regularly uses validated measurement instruments.

1. (Unsatisfactory) Incomplete interviews. Disorganized, awkward. Lacks focus. Misses important patient cues or findings. Fails to collect all elements of H&P in reasonable time frame. Omits critical portions of exam.

2. (Marginal) Obtains basic data but often misses significant abnormal findings, comorbidities, pertinent positives and negatives. Inefficient.

3. (Satisfactory) Conducts complete interviews. Solicits data for all elements of H&P, including pertinent positives and negatives. May lack logical, flowing sequence or transitions. Some backtracking.

4. (Good) Conducts well paced, logically sequenced interviews. Rarely misses important findings. Skillfully solicits sensitive data. Shows flexibility in style. Sometimes uses validated clinical interview questions.

5. (Excellent/Outstanding) Artful, efficient, focused interviews. Accurately detects subtle or sensitive findings. Uses selected interview techniques adaptively. Handles difficult patients effectively. Regularly uses validated diagnostic interview questions.

1. (Unsatisfactory) Disorganized, incomplete. Ill-prepared. Major omissions.

2. (Marginal) Unfocused. Contains basic data but requires interruption for assistance or clarification. May ramble, include extraneous information.

3. (Satisfactory) Usually complete, organized presentations include all basic information in standard format.

4. (Good) Consistently thorough, organized, concise presentation. Precise language. Shows integration and understanding of data.

5. (Excellent/Outstanding) Polished, confident, fluent, succinct presentations. Shows high-level synthesis and understanding of data. Tailors style and length of talk to situation.

1. (Unsatisfactory) Misses major problems. Cannot interpret basic data. Unable to correctly identify a working diagnosis without assistance.

2. (Marginal) Usually identifies the major patient problem correctly. May not integrate all aspects of data. May report data without analysis. Problem list and differential incomplete.

3. (Satisfactory) Independently identifies major problems, a working diagnosis and key differentials. Constructs an accurate multi-axial diagnosis and rudimentary biopsychosociocultural formulation.

4. (Good) Develops a complete differential diagnosis. Regularly identifies predisposing, precipitating and maintaining factors. Formulation shows appreciation of interaction between problems or comorbid conditions. Correctly prioritizes problems.

5. (Excellent/Outstanding) Develops a complete differential diagnosis. Regularly identifies predisposing, precipitating and maintaining factors. Formulation shows appreciation of interaction between problems or comorbid conditions. Correctly prioritizes problems.

1. (Unsatisfactory) Difficulty understanding or formulating treatment options.

2. (Marginal) Requires prompting to identify elements of treatment plan. May set unrealistic goals or fail to adequately collaborate with patient and family.

3. (Satisfactory) With assistance, identifies appropriate treatment options and weighs choices to create arealistic multi-modal and/or multi-disciplinary plan. Involves patient and family in planning.

4. (Good) Demonstrates expanded understanding of treatment options. Weighs risks and benefits. Show initiative and independent decision-making in treatment choices.

5. (Excellent/Outstanding) Treatments are consistently collaborative, evidence-based, individualized for each patient, tailored to local resources, cost-effective and designed to maximize adherence.

1. (Unsatisfactory) Unsafe, erroneous or neglectful practices. May fail to monitor or followup patients closely. May cause iatrogenic disease. May be uninvolved in decision-making.

2. (Marginal) Involved in patient care but may be passive or indecisive, following direction of others. Rarely suggests more than routine care. May allow lapses in care. May have narrow focus in patient care.

3. (Satisfactory) Effectively assumes significant responsibility for patient management. Provides appropriate, high quality care. Shows sound clinical judgment. Uses tests appropriately. Performs procedures safely. Recognizes and handles emergencies competently. Reevaluates patients regularly and modifies plans with assistance, as needed.

4. (Good) Provides comprehensive care for a full caseload efficiently. Uses an orderly sequence of testing. Able to anticipate problems. Effectively handles many patient problems independently.

5. (Excellent/Outstanding) Effectively prioritizes multiple patient care demands. Reasons well in complex or ambiguous cases. Shows high degree of initiative and independence in monitoring and planning care. Applies preventive interventions before problems arise.

1. (Unsatisfactory) Major deficiencies in basic concepts and key medical facts. Fails to apply basic science and clinical principles to care of patients.

2. (Marginal) Weak knowledge base. Many gaps in fundamental facts.

3. (Satisfactory) Consistently demonstrates an adequate fund of knowledge. Applies basic science and clinical principles to patient care.

4. (Good) Strong fund of knowledge. Considerable, expanded understanding of psychopathology and mechanisms of disease.

5. (Excellent/Outstanding) Comprehensive and up-to-date knowledge. Demonstrates strong investigatory and analytic thinking. Articulates current issues in controversial or unsolved areas of medicine. Supports statements with literature references.

1. (Unsatisfactory) Fails to perform self evaluation. Resists or ignores feedback. Fails to use EBM skills to pursue self-improvement or enhance patient care. Doesn’t facilitate learning for others. Passive or negative participant in seminars.

2. (Marginal) Weak evidence of self directed learning. Limited use of EBM skills in patient care. Limited teaching activities.

3. (Satisfactory) Shows a growing habit of self-assessment and disciplined self-directed learning. Shows at least novice-level information searching and EBM skills. Accepts feedback without defensiveness and uses it for change. Facilitates learning of others.

4. (Good) Committed to learning excellence. Seeks out and consistently incorporates feedback into improvement activities. Demonstrates regular, disciplined self-directed learning. Expanded EBM skills.

5. (Excellent/Outstanding) Constantly evaluates own performance. Shows high level of initiative, eagerness and success in self-directed, evidence based learning. Serves as a resource for others. Highly regarded for teaching. Positive participant/leader in seminars and rounds.

1. (Unsatisfactory) Unethical behaviors. Shows insensitivity to patient concerns. Unable to establish rapport or an adequate working relationship with patients or families. Lacks integrity, respect, empathy.

2. (Marginal) Lacks skill in listening and communicating effectively. Difficulty managing boundaries. Episodes of miscommunication with patients and families.

3. (Satisfactory) Creates and sustains a therapeutic and ethically sound relationship with patients and their families. Communicates effectively. Demonstrates caring, respectful behaviors that supercede self-interest. Listens effectively. Effectively counsels and educates patients and their families. Keeps appropriate boundaries.

4. (Good) Able to establish a relationship with some more difficult patients (e.g. with volatility or paranoia). Demonstrates consistent empathy. Expanded listening and verbal skills.

5. (Excellent/Outstanding) Able to create and sustain therapeutic relationship with very challenging or difficult patients. Effectively manages a volatile family meeting. Handles complex boundary issues skillfully. Manages own anxiety well. Shows maturity in use of self.

1. (Unsatisfactory) Irresponsible, unreliable, or uncooperative. May be antagonistic, disruptive, arrogant. He/she may be the source of complaints by personnel.

2. (Marginal) Shows difficulty working with others. May show inflexibility, lack of consideration or respect. May make excessive demands.

3. (Satisfactory) Works effectively with associates. Invites mutual respect. Regarded as accountable by others.

4. (Good) Regarded as a team player. Shows ability to be flexible, compromise, admit errors. Recognizes the strengths and limits of others’ skills.

5. (Excellent/Outstanding) Shows high level of teamwork, collegiality, leadership. Effectively uses skills of others for consultation and supervision. Brings out the best in others.

1. (Unsatisfactory) Often absent or late. Unfinished patient care tasks. Lacks follow-up. Often fails to plan. Misses changes in patient status. Delegates tasks inappropriately. Fails to respond to pages. Often looks sloppy.

2. (Marginal) Occasionally absent or late. Unavailable at times. Erratic in planning and follow-up. Unreliable response to pages. Looks untidy at times. Erratic compliance with housestaff + residency office requirements.

3. (Satisfactory) Satisfactory attendance. Generally punctual. Usually available when needed. Usually reliable & timely response to pages. Keeps appearance tidy + professional. Complies with administrative requirements.

4. (Good) Commendable attendance, punctuality. Always answers pages quickly.

5. (Excellent/Outstanding) Impeccably punctual. Unswervingly diligent, immediately responsive. Anticipates needs. Highly reliable.

1. (Unsatisfactory) Inaccurate data. Overdue. Misleading. Disorganized. Important omissions. Rationale unclear. Change or progress unclear. Poor grammar, typos. Poses legal risk.

2. (Marginal) Lacks sufficient organization, completeness, clarity or legibility. Inadequate compliance with electronic medical record requirements. Moderate risk potential.

3. (Satisfactory) Records are generally complete, well-written and timely. Illustrate progression of care. Records include basic elements to satisfy billing, legal and future patient care needs. Compliant with all electronic medical record requirements.

4. (Good) Notes are particularly clear and well-organized, useful for reference.

5. (Excellent/Outstanding) Exceptionally complete and timely record keeping. May include courtesy correspondence, transfer and termination notes, patient summary data, flow charts, rating scales.

1. (Unsatisfactory) Lacks integrity, honesty, respect. Unsatisfactory ethical behaviors. May place self-interests above patient interests. May not share credit or accept blame. Insensitive to patient diversity issues.

2. (Marginal) Irregularly applies professional ethical standards to decision making. Requires prompting in matters of professional identity and attitude.

3. (Satisfactory) Applies professional ethical standards to patient care. Honest. Demonstrates sensitivity and responsiveness to patients’ culture, age, gender and disabilities.

4. (Good) Most often chooses to do the “right thing” or the higher standard in patient care. Models respect for diverse patients.

5. (Excellent/Outstanding) Impeccable level of accountability, integrity, dedication to patient care. Respects human dignity in the most challenging patients. Serves as a role model for others.

1. (Unsatisfactory) Does not show evidence of reading. Poor initiative. Fails to acknowledge errors or limits to knowledge. Poorly responsive to constructive criticism.

2. (Marginal) Fails to seek supervision. Only partially responsive to feedback. May require reminders to seek information.

3. (Satisfactory) Works at expected level of independence. Completes reading assignments reliably. Recognizes limits to knowledge or skill. Seeks help and supervision when needed. Recognizes errors. Accepts feedback without defensiveness.

4. (Good) Demonstrates curiosity and eagerness to learn. Seeks additional reading. Seeks out and responds to feedback.

5. (Excellent/Outstanding) Exemplary drive to learn. Demonstrates regular habits of self-directed learning. Goes out of his/her way to help others learn.

1. (Unsatisfactory) No appreciation of various structures used to provide mental health care. Frequently mismanages patients due to these deficiencies. Excessive, redundant or inappropriate use of tests or treatments. Doesn’t allocate limited resources appropriately. Ignores available clinical practice guidelines or standards of care.

2. (Marginal) Significant weaknesses in ability to adapt treatment to the available resources for the patient.

3. (Satisfactory) Appreciates the organization of mental health care systems and plans individual patients’ care accordingly. Practices cost-effective medicine. Advocates for quality patient care with case managers, utilization review personnel, etc. Assists patients and families in dealing with system complexities.

4. (Good) Shows particular initiative in assisting patients with proper resources and guiding them through the system, partnering with others to improve care. Effective in containing costs. Uses validated clinical practice guidelines where appropriate.

5. (Excellent/Outstanding) Sophisticated understanding of mental health care systems. Develops elegant and imaginative strategies to maximize care. May be active as an advocate in mental health policy or community service.

Please rate the fellow’s overall performance based on the level of skill expected from the clearly satisfactory resident at this stage of training.