ࡱ> XZW[@ 2bjbj44 EViVi840000:::8r4\f'&T4&&&&&&&$(R*&-r"&00 'RRRF08&R&RFRVE$@h$ }6:8.$ $6'0f'$ +f+$0000+$XrR\&&& :<:  Division of Cardiovascular Diseases 951 Court Avenue, Room 353D Memphis, TN 38163 (901) 448-5750 Fellow Evaluation of Faculty Attending:  FORMDROPDOWN  Dates: (mm/yyyy)  FORMTEXT       Exposure to Attending: (Check all that apply)  FORMCHECKBOX  Clinical (CICU, Consults, Clinic)  FORMCHECKBOX  Diagnostic Interpretation (EKG, Echo, Stress tests, Nuclear)  FORMCHECKBOX  Procedures (Cath lab, TEE, Stress Echo, Pacemakers) Setting: (Check all that apply)  FORMCHECKBOX  Inpatient FORMCHECKBOX  Outpatient FORMCHECKBOX  Echo Lab FORMCHECKBOX  Stress Lab FORMCHECKBOX  Cath Lab FORMCHECKBOX  Lecture only Institution:  FORMDROPDOWN    YES  NODid the attending provide an initial orientation and discuss expectations?  FORMCHECKBOX  FORMCHECKBOX Did the attending provide feedback on your performance during the rotation? FORMCHECKBOX  FORMCHECKBOX Did the attending discuss your performance, strengths and weaknesses, and areas requiring improvement at the end of the rotation? FORMCHECKBOX  FORMCHECKBOX Was the AMOUNT and LEVEL of teaching provided appropriate to your needs? FORMCHECKBOX  FORMCHECKBOX Did the attending supply evidence supporting his recommendations (e.g., references) when appropriate and/or requested? FORMCHECKBOX  FORMCHECKBOX Was the attending responsive and available as needed for questions? FORMCHECKBOX  FORMCHECKBOX Did the attending treat you with the respect and professionalism appropriate for a subspecialty fellow in training? FORMCHECKBOX  FORMCHECKBOX Did the attending maintain an appropriate level of ongoing responsibility (supervisory and direct care) for the patients under you care? FORMCHECKBOX  FORMCHECKBOX Were you provided independence appropriate for your level of capability? FORMCHECKBOX  FORMCHECKBOX Was the attending cooperative in allowing you to meet your other clinical and educational responsibilities? FORMCHECKBOX  FORMCHECKBOX  Overall Rating:  FORMCHECKBOX  Poor,  FORMCHECKBOX  Marginal,  FORMCHECKBOX  Satisfactory,  FORMCHECKBOX  Good,  FORMCHECKBOX  Outstanding Additional Comments:  FORMTEXT  V  " $ & B D F P ^ r t 0 1 ? @ A  śꄑwjjhXCJUjNhXCJUjhXCJUjhXCJUjhXUmHnHujfhXU hXCJjhXUjhXU hX5CJ hX5CJhX5CJOJQJhX hXCJjhXCJUmHnHu)V  0    n(v:n(v:n(v:n(v:n(v:n(v:n(n(n(v:n(n(v:n(v:n(v:n(n(. v:hv:$If !$a$$a$$a$222      ! / 0 1 ; < J K L Y Z h i j t u   yr hX5CJ!jhX5CJUmHnHuj)hXCJU hX5CJjLhXCJUjhXCJUjhXCJUjhXCJUjhXCJUj6hXCJU hXCJjhXCJUhX, ; X Y t $. v:hv:iΐ. v:hv:Gkdo$$Iflp0 ( @4 la$IfGkd$$Ifly0 ( @4 la 7n(v:n(n(v:n(v:jjMjTZkd$$IflzF< "%    4 la$IfGkd$$IflL0 ( @4 la  # 5 6 [v:Mv:k[v:Mv:ZkdP $$IflF< "%    4 la $$Ifa$ & F$If ! 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Ha?option11"n (  VB  C D"\  C Aut"VB  C D"VB  C D"V  # " B S  ?@ #n(@Tp@t(t0(0tq^#qt:0P"u& Dropdown1Text1Check1Check2Check3Check4Check5Check6Check7Check8Check9 Dropdown2Check10Check11Check17Check18Check19Check20Check21Check22Check23Check24Check25Check26Check27Check28Check29Check30Check31Check32Check33Check34Check13Check12Check14Check15Check16Text21!<Zu$*<4F6HRd1QsA   !"#$% A1Lj"4:LDVFXbt)AaA |@DLTMLN=CNTD :=GGPS   ' ' . 6 A   NRXX & & - 5 < < A   =*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceType>*urn:schemas-microsoft-com:office:smarttags PostalCode9 *urn:schemas-microsoft-com:office:smarttagsState8 *urn:schemas-microsoft-com:office:smarttagsCity9 *urn:schemas-microsoft-com:office:smarttagsplace    ko > A 5;u A ::6)N3X5ZQv = A  A Arsalan Shirwany Jimmy KlemisCt td*86?f|> hh^h`OJQJo(h88^8`.h^`.h L ^ `L.h  ^ `.hxx^x`.hHLH^H`L.h^`.h^`.hL^`L.h^`.h^`.hpLp^p`L.h@ @ ^@ `.h^`.hL^`L.h^`.h^`.hPLP^P`L.?ftd*CtX+ ;XYt#56);MN3EWX5GYZQcuv > A )+5=6@/(@ PP@P2UnknownGz Times New Roman5Symbol3& z Arial9Garamond5& zaTahoma"qhXsFXsFSaQQ!24d3H(?X University of Tennessee, MemphisArsalan Shirwany Jimmy Klemis   Oh+'0 4 LX t   !University of Tennessee, MemphisicrnivArsalan Shirwanynesrsarsa Faculty%20Evaluation%20Form.dot Jimmy Klemislua2mmMicrosoft Word 10.0@F#@6@}+@}+Q՜.+,0  hp  Memphis VA Medical Centern{ !University of Tennessee, Memphis Title  !"$%&'()*+,-./023456789:;<=>?@ABCDEFHIJKLMNPQRSTUVYRoot Entry F 6[Data #T1Table1+WordDocumentESummaryInformation(GDocumentSummaryInformation8OCompObjj  FMicrosoft Word Document MSWordDocWord.Document.89q