Skip to main content
Skip to after header navigation
Skip to site footer

American Head & Neck Society

Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.

Search site

Donate

Your AHNS Member Panel

Search

About
Join AHNS
For Members
For Patients
For Trainees
Meetings
Heads Up!
Job Board
- Post a Job
Your AHNS Member Panel
Donate
Login
- Password Reset

ATC – Trainee Evaluation Form

To be completed by the faculty of the training program

Company

This field is for validation purposes and should be left unchanged.

Name of Program

Fellow's Name

First Last

PG Level:

Name of Evaluator

First Last

Date of Evaluation

MM slash DD slash YYYY

Evaluation for FY2025-2026

Mid-Term (January 2026)

End of Term (June 2026)

Evaluator Role

Role: Please Specify

Evaluator Email

Enter your email to receive a copy of your responses.

Fellow Evaluation

For each of the following categories, please indicate: Not observed/ Not applicable, Outstanding, Satisfactory, Needs Improvement OR Unsatisfactory

Fund of knowledge for head and neck surgical oncology

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Fund of knowledge for microvascular reconstructive surgery

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Thoroughness of patient management

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Clinical problem solving/clinical judgment

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Emergency and critical care patient management

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Surgical skills: Micro

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Surgical skills: Ablative

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Professional behavior with colleagues and peers

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Rapport with patients, empathy

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Ability to effectively communicate clinical information to patients

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Rapport with other health professionals

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Clinical research performance

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Efficiency and work habits

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Ownership of patient care

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Teaching and instructing ability

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Administrative skills

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Endocrine decision making

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Proficiency in ambulatory procedures

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Neck ultrasound

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Ultrasound guided FNA

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Overall clinical performance

Not observed/Not applicable	Outstanding	Satisfactory	Needs Improvement	Unsatisfactory

Additional Fellowship Activities

For each of the following categories, please indicate: Adequate OR Insufficient. Write in answers where prompted.

Time spent in clinic

Adequate	Insufficient

Comments

Average number of days spend in clinic weekly

Satisfactory Completion of Key Indicator Case Goals

Yes	No

Specific Case Type Concerns

AHNS Virtual Tumor Board Attendance: Met 60% attendance benchmark?

Yes	No

Usage of AHNS Curriculum: At least 60% completed?

Yes	No

Completion of questions distributed through Dosed Daily: Met 70% participation benchmark?

Yes	No

AHNS Journal Club participation

Adequate	Insufficient

Formal Multidisciplinary Exposure:

Radiation oncology

Adequate	Insufficient

Medical oncology

Adequate	Insufficient

Comments/Details on participation

Multidisciplinary Tumor Board Involvement

For each of the following categories, please indicate: Yes OR No

Fellow presents cases at tumor board

Yes	No

Fellow organizes tumor board

Yes	No

Evaluation Type

Interim: 6 Month Evaluation

End of the Year: Summation Evaluation

Other

If 'other' please describe(Required)

Evaluation Comments

Additional Documentation: If you have your own program evaluation form or other documentation you wish to include with this fellow evaluation, please upload it here.

Max. file size: 512 MB.

Δ

Share:

Facebook
X
LinkedIn