Department of Pediatrics

DEPARTMENT OF PEDIATRICS

Mission

Improving the lives of children through excellence in advocacy, education, research and clinical care

FACULTY PERFORMANCE AND GOALS

The purpose of the faculty performance appraisal system is to link the appraisal process to your goals and to the goals and missions of the University, Department, and Division, and to facilitate communication between the Division Chief and the faculty member. This form will provide a framework for your dialogue with your Division Chief. This document is not intended to be used beyond these meetings.

For the period of

Today's Date:

FACULTY GENERAL INFORMATION

Division:

% FTE in Division:

Rank and Track:

Employment Date:

Years in Rank:

Please enter the percentage of time spent in the following activities:

Education % Scholarship % Clinical Care % Administration % Other % Total 100 %

Faculty Performance Evaluation 8/19/04 1 of 8 Clinical Care

Describe your clinical activities and indicate an overall rating of Exceeds Expectation, Meets Expectation, or Opportunity for Improvement. Consider the following activities: inpatient and outpatient service, efforts to enhance clinical care, patient/parent comments, and clinical honors and awards.

Overall Rating Self-Evaluation Division Chief Evaluation Opportunity Opportunity for for Exceeds Expectation Meets Expectation Improvement Exceeds Expectation Meets Expectation Improvement

Clinical responsibilities in the previous year: (Attach additional sheet, if necessary)

Clinical goals for this year:

Division Chief comments:

Faculty Performance Evaluation 8/19/04 2 of 8 Education

Describe your education activities and indicate an overall rating of Exceeds Expectation, Meets Expectation, or Opportunity for Improvement. Consider the following activities: medical lectures per clerkship, resident lecture series per resident year, Grand Rounds presentations, teaching honors and awards, small group leadership, post-graduate education (CME lectures, etc.), curriculum development, graduate student training, laboratory training for post- doctoral fellows and visiting scientists, and invited lecturer or visiting professor.

Education contributions in the previous year: (Attach additional sheet, if necessary)

Education goals for this year:

Faculty Performance Evaluation 8/19/04 3 of 8 Scholarship

Describe your scholarship activities and indicate an overall rating of Exceeds Expectation, Meets Expectation, or Opportunity for Improvement. Consider the following activities:

A. Publications (list and attach copies): C. Grants and Contracts (list) Journal articles published during the last academic In development (what is planned, what is year planned submission date) Abstracts accepted for presentation Submitted Medical books and chapters Unfunded (include score) B. Presentations (list topic, what meeting, when, and Funded (include score and budget) where) Oral and poster presentations at national/ D. Research honors and awards international meetings Oral and poster presentations at regional meetings

Scholarship accomplishments in the previous year: (Attach additional sheet, if necessary)

Scholarship goals for this year:

Faculty Performance Evaluation 8/19/04 4 of 8 Administration

Describe your administrative activities and indicate an overall rating of Exceeds Expectation, Meets Expectation, or Opportunity for Improvement. Consider activities in the following arenas: medical school, hospital, department, other university service, community, service honors and awards, and professional societies.

Administrative responsibilities in the previous year: (Attach additional sheet, if necessary)

Administrative goals for this year:

Faculty Performance Evaluation 8/19/04 5 of 8 General Effectiveness as a Faculty Member

Indicate rating of Exceeds Expectation, Meets Expectation, or Opportunity for Improvement for each category.

Self-Evaluation Division Chief Evaluation

Opportunity Opportunity Exceeds Meets for Exceeds Meets for Expectation Expectation Improvement Expectation Expectation Improvement

Adaptability

How well do you adjust to change? Consider your ability to learn quickly, adapt to changes in job assignments, methods/ processes, personnel, or surroundings.

Dependability

How reliable are you? Consider your willingness to take on responsibilities and to be accountable for them.

Initiative and Resourcefulness

Do you see things to be done and then take action? Consider your ability to contribute, develop, and/or carry out new ideas or methods/processes. Consider also your ability to be a self-starter, to offer suggestions, to anticipate needs, and to seek additional tasks as time permits.

Interpersonal Relationships

Do you work effectively with others (superiors, peers, subordinates)? Consider respect and courtesy shown to others, the willingness to provide and accept guidance in a constructive manner, how your attitude affects the work area, and how it reflects on the division as well as your own position. Are apparel, manners, and sociability appropriate to the job responsibilities?

Faculty Performance Evaluation 8/19/04 6 of 8 General Effectiveness as a Faculty Member

Indicate rating of Exceeds Expectation, Meets Expectation, or Opportunity for Improvement for each category.

Self-Evaluation Division Chief Evaluation

Opportunity Opportunity Exceeds Meets for Exceeds Meets for Expectation Expectation Improvement Expectation Expectation Improvement

Judgment

Do you exhibit good judgment? Consider the ability to evaluate facts and make sound decisions and use of reasoning to identify, solve, and prevent problems. (Not just related to clinical activities.)

Quality of Work

How accurate, complete, and timely is your work.

Originality/Creativity

Do you see alternative solutions to problems? Do you pose new ideas or novel concepts for consideration?

Overall

Are you an effective faculty member? Do you consider yourself a role model for other faculty and trainees?

Faculty Performance Evaluation 8/19/04 7 of 8 Professional activities in which you wish to spend….

More time:

Less time:

Your plans for faculty development:

Division Chief summary:

Signatures Faculty Date:

Division Chief Date:

Faculty Performance Evaluation 8/19/04 8 of 8