Evaluation of the Fellow

Supervisor’s Evaluation of Fellow

Fellow: ___________________________

Supervisor:________________________

Date of Rating: ____________________

SCALE

4 Superior performance: demonstrates, abilities, knowledge and maturity well beyond what would be expected of an average independent practitioner

3 Average performance necessary for independent practice: demonstrates the skills, knowledge, and maturity necessary for independent practice

2 Appropriate for fellowship level; shows adequate knowledge, skills, and maturity appropriate for fellowship, but there is more work needed to be fully independent in practice

1 Below fellowship level; quality of work overall was more at the level of an fellow, can mimic supervisor but does not show independent understanding or practice of the skill, relevant knowledge, or maturity to operate even semi-independently

N/A Not applicable

RATINGS RELATED TO PROGRAM GOALS

Goal 1: Demonstrates “advanced skills in neuropsychological assessment sufficient for independent practice and board certification in neuropsychology.”

Rating                 4                           3                          2                          1                         N/A

Comments:

Goal 2: Demonstrates “advanced skills in treatment recommendations and interventions for neuropsychological disorders sufficient for independent practice.”

Rating                 4                           3                          2                          1                         N/A

Comments:

Goal 3: Demonstrates “Advanced skills in consultation with patients, families, and treatment teams sufficient for independent practice.”

Rating                 4                           3                          2                          1                         N/A

Comments:

Goal 4: Demonstrates “Advanced knowledge of neuropsychology (e.g., etiologic mechanisms and processes).

Rating                 4                           3                          2                          1                         N/A

Comments:

Goal 5: Advanced knowledge of research issues and methodological issues in neuropsychology.

Overall Rating (note, ratings below 2 will require a remediation plan).

Rating                 4                           3                          2                          1                         N/A

Comments:

Fellow Signature (date): ______________________________________

Supervisor Signature (date): ___________________________________

Training Lead Signature (date): _________________________________