American Head & Neck Society

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

AHNS Fellowship – Faculty Evaluation Form

This form is to be completed by the graduating fellow as a prerequisite to receiving your Certificate of Completion.

These responses are in the interest of improving the fellowship and will be kept strictly confidential.

Six evaluation forms are presented below – if you wish to evaluate more than six faculty, please contact the AHNS administrative office for an additional form. You do not need to complete all 6 forms.

ATC - Fellowship Faculty Evaluation

"*" indicates required fields

Name*
MM slash DD slash YYYY
MM slash DD slash YYYY
1 = outstanding2 = Good3 = Fair4 = Poor
Directly worked with during fellowship
Knowledge of surgical oncology
Knowledge of head & neck oncology
Discusses pre-op evaluation & indications for surgery in clinic
Challenges me to create management plans
Quality of informal teaching
Availability for informal consultation
Stimulates enthusiasm for learning
Stimulates clinical research projects
Stimulates basic science research projects
Faculty member's surgical technique
Faculty member's intra-operative decision making
Faculty member allows independent operative teaching
Faculty member's case load is adequate for teaching
Faculty member's concern for my educational/future plans
Faculty member gives constructive feedback
Faculty member as a role model for fellows
Faculty member's interpersonal skills with fellows
Faculty member gives respect
Overall Assessment
1 = outstanding2 = Good3 = Fair4 = Poor
Directly worked with during fellowship
Knowledge of surgical oncology
Knowledge of head & neck oncology
Discusses pre-op evaluation & indications for surgery in clinic
Challenges me to create management plans
Quality of informal teaching
Availability for informal consultation
Stimulates enthusiasm for learning
Stimulates clinical research projects
Stimulates basic science research projects
Faculty member's surgical technique
Faculty member's intra-operative decision making
Faculty member allows independent operative teaching
Faculty member's case load is adequate for teaching
Faculty member's concern for my educational/future plans
Faculty member gives constructive feedback
Faculty member as a role model for fellows
Faculty member's interpersonal skills with fellows
Faculty member gives respect
Overall Assessment
1 = outstanding2 = Good3 = Fair4 = Poor
Directly worked with during fellowship
Knowledge of surgical oncology
Knowledge of head & neck oncology
Discusses pre-op evaluation & indications for surgery in clinic
Challenges me to create management plans
Quality of informal teaching
Availability for informal consultation
Stimulates enthusiasm for learning
Stimulates clinical research projects
Stimulates basic science research projects
Faculty member's surgical technique
Faculty member's intra-operative decision making
Faculty member allows independent operative teaching
Faculty member's case load is adequate for teaching
Faculty member's concern for my educational/future plans
Faculty member gives constructive feedback
Faculty member as a role model for fellows
Faculty member's interpersonal skills with fellows
Faculty member gives respect
Overall Assessment
1 = outstanding2 = Good3 = Fair4 = Poor
Directly worked with during fellowship
Knowledge of surgical oncology
Knowledge of head & neck oncology
Discusses pre-op evaluation & indications for surgery in clinic
Challenges me to create management plans
Quality of informal teaching
Availability for informal consultation
Stimulates enthusiasm for learning
Stimulates clinical research projects
Stimulates basic science research projects
Faculty member's surgical technique
Faculty member's intra-operative decision making
Faculty member allows independent operative teaching
Faculty member's case load is adequate for teaching
Faculty member's concern for my educational/future plans
Faculty member gives constructive feedback
Faculty member as a role model for fellows
Faculty member's interpersonal skills with fellows
Faculty member gives respect
Overall Assessment
1 = outstanding2 = Good3 = Fair4 = Poor
Directly worked with during fellowship
Knowledge of surgical oncology
Knowledge of head & neck oncology
Discusses pre-op evaluation & indications for surgery in clinic
Challenges me to create management plans
Quality of informal teaching
Availability for informal consultation
Stimulates enthusiasm for learning
Stimulates clinical research projects
Stimulates basic science research projects
Faculty member's surgical technique
Faculty member's intra-operative decision making
Faculty member allows independent operative teaching
Faculty member's case load is adequate for teaching
Faculty member's concern for my educational/future plans
Faculty member gives constructive feedback
Faculty member as a role model for fellows
Faculty member's interpersonal skills with fellows
Faculty member gives respect
Overall Assessment
1 = outstanding2 = Good3 = Fair4 = Poor
Directly worked with during fellowship
Knowledge of surgical oncology
Knowledge of head & neck oncology
Discusses pre-op evaluation & indications for surgery in clinic
Challenges me to create management plans
Quality of informal teaching
Availability for informal consultation
Stimulates enthusiasm for learning
Stimulates clinical research projects
Stimulates basic science research projects
Faculty member's surgical technique
Faculty member's intra-operative decision making
Faculty member allows independent operative teaching
Faculty member's case load is adequate for teaching
Faculty member's concern for my educational/future plans
Faculty member gives constructive feedback
Faculty member as a role model for fellows
Faculty member's interpersonal skills with fellows
Faculty member gives respect
Overall Assessment
This field is for validation purposes and should be left unchanged.