Evaluation of Professional Traits/Behaviors of

O’Bleness Memorial Hospital Interns/Residents during Ethics Education

Competency: Professionalism

Please read each statement and circle the number that corresponds to your response (1-Strongly Disagree, 2-Disagree, 3-Neutral, 4-Agree, 5-Strongly Agree)

Reliability and Responsibility

The facilitator:

Can be depended upon to do his/her duty 1 2 3 4 5

Follows through on tasks agreed upon 1 2 3 4 5

Arrives on time for class/discussion 1 2 3 4 5

Maturity

The facilitator:

Behaves respectfully 1 2 3 4 5

Accepts blame for failure 1 2 3 4 5

Makes appropriate demands 1 2 3 4 5

Critique and Feedback

The facilitator:

Accepts criticism 1 2 3 4 5

Looks at self objectively 1 2 3 4 5

Takes steps to correct shortcomings 1 2 3 4 5

Provides specific and constructive feedback 1 2 3 4 5

Communication Skills

The facilitator:

Listens well 1 2 3 4 5

Engages in effective facilitation behaviors 1 2 3 4 5

Effectively identifies ethical issues

Uses language appropriate to circumstances

Honesty and Integrity

The facilitator:

Adheres to professional and/or ethical standards 1 2 3 4 5

Is honest 1 2 3 4 5

Corrects errors 1 2 3 4 5

What behaviors did the facilitator show that demonstrates professionalism (aside from the characteristics listed above)? ____________________________________

_____________________________________________________________________

End of Evaluation. Thank you!