This document contains a resident evaluation form for a neonatal intensive care unit (NICU) rotation. It evaluates the resident on their medical knowledge, patient care skills, interpersonal/communication skills, professionalism, practice-based learning and improvement, and systems-based practice. The attending physician rates the resident's performance in various areas as functioning above, at, or below the expected level for their year of training. Space is also provided for comments on the resident's strengths, areas for improvement, procedures observed, and an overall performance rating.

1. RESIDENT EVALUATION FOR THE NICU Year in Training____
Resident’s Name:
Attending’s Name:
Month/Date:
Functions above Functions at Functions
expected level appropriate level marginally Deficient N/A
MEDICAL KNOWLEDGE:
1. Understands the neonatal consequences of high risk maternal
conditions such as chorioamnionitis, preterm labor/rupture of membranes,
pre-eclampsia/eclampsia, oligo/polyhydramnios, diabetes,
multiple gestation, substance abuse, placental
abnormalities.     
2. Understands how to evaluate and manage common conditions
such as respiratory distress syndrome, transient tachypnea
of the newborn, meconium aspiration, persistent pulmonary hypertension,
bronchopulmonary dysplasia, apnea, atelectasis, air leaks, pneumonia, congenital
heart disease, hypotension/shock, patent ductus arteriosus, hypo
and hyperglycemia, necrotizing enterocolitis, sepsis, asphyxia, anemia of
prematurity, seizures.     
3. Appropriately orders and interprets laboratory tests and
imaging studies.     
4. Understands the value and application of non-invasive
monitoring tools such as pulse oximetry and transcutaneous
C02 monitoring.     
PATIENT CARE
5. Performs a complete history and physical exam
in a timely manner.     
6. Has attempted and/or successfully placed umbilical arterial
and venous catheters.     
7. Accurately interprets blood gases and institutes respiratory support
or alters ventilator settings accordingly.     
8. Effectively manages fluids and electrolytes.     
9. Understands the basic principles of hyperalimentation, enteral nutrition and advances
nutrition according to the patient’s needs and
clinical status.     
INTERPERSONAL SKILLS AND COMMUNICATION
10. Writes orders clearly and accurately and communicates effectively with
the nursing and respiratory therapy staff.     
11. Demonstrates a caring attitude and interest in     
communicating with patients and families

2. 12. Utilizes contributions of others in patient care     
13. Shows tactfulness when dealing with others     
14 Receptive to feedback and appropriately     
modifies behavior to improve performance
15. Contributes to good morale among peers     
16. Is an effective teacher of peers     
17. Relates well with staff and peers     
PROFESSIONALISM
18. Appreciates the ethical issues surrounding the infant of
borderline viability.     
19. Completes assigned tasks without reminder     
20. Able to handle expected workload     
21. Keeps assigned duty hours     
22. Considerate of others- punctuality     
23. Considerate of others- cultural sensitivity     
24. Is a good role model     
PRACTICE-BASED LEARNING AND IMPROVEMENT
25. Demonstrates a willingness to learn from errors     
26. Uses medical literature to improve patient     
Management
27. Identifies areas of weakness and seeks improvement     
SYSTEMS-BASED PRACTICE
28. Appropriately requests other subspecialty consultation when
indicated.     
29. I have observed resident perform the following procedures:

3. 30. What are some of this resident’s strengths?
31. What are some areas to be improved?
32. Additional Comments:
33. Overall, resident is performing above , at ,
or below that expected for level of training
Date: Signature:
I have had the opportunity to review the above with the evaluator
Date: Signature:
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