1. Resident Self Assessment Where do you fall on the continuum for each of the following? Please make an “X” on each line then date it: History Novice Advanced Beginner CompetentProficientExpert 1.My ability to obtain an accurate, detailed and relevant history of a new complaint in an efficiently customized, prioritized and hypothesis driven fashion. 2.My ability to obtain an accurate, detailed and verified history of current medication use employing secondary sources if necessary (family, pharmacy, medical records). 3.My ability to obtain an accurate, detailed and verified history of chronic pain employing secondary sources if necessary (family, pharmacy, medical records). 4.My ability to obtain a complete past medical history for a patient’s active clinical problems in an efficient and customized fashion utilizing secondary sources when necessary (family, medical records). 5.My ability to role model gathering subtle and reliable information from the patient for junior members of the healthcare team.

2. Resident Self Assessment Where do you fall on the continuum for each of the following? Please make an “X” on each line then date it: Physical Exam Novice Advanced Beginner CompetentProficientExpert 1.Perform an accurate, focused physical examination that is appropriately targeted to the patient’s complaints and medical conditions. Identify pertinent abnormalities using common maneuvers. 2.Perform and accurate cardiovascular examination identifying subtle or unusual findings that may influence clinical decision making. 5.Perform and accurate lung examination identifying subtle or unusual findings that may influence clinical decision making. 6.Perform and accurate abdominal examination identifying subtle or unusual findings that may influence clinical decision making. 7.Perform and accurate musculoskeletal examination identifying subtle or unusual findings that may influence clinical decision making. 8.Perform and accurate neurological examination identifying subtle or unusual findings that may influence clinical decision making. 10.Perform and accurate pelvic examination identifying subtle or unusual findings that may influence clinical decision making. 11.Perform and accurate knee examination identifying subtle or unusual findings that may influence clinical decision making. 12.Perform and accurate shoulder examination identifying subtle or unusual findings that may influence clinical decision making. 13.Perform and accurate hip examination identifying subtle or unusual findings that may influence clinical decision making. 14.Demonstrate and teach how to elicit important physical findings for junior members of the healthcare team.

3. Resident Self Assessment Where do you fall on the continuum for each of the following? Please make an “X” on each line then date it: Patient Care Novice Advanced Beginner CompetentProficientExpert 1.Develop prioritized differential diagnoses, evidence-based diagnostic and therapeutic plan for common ambulatory conditions. 2.Provide appropriate, patient-centered preventive care. 3.Teach patient about self-care. 4.Create an updated active problem list complete with clinical goals. 5.Customize care in the context of the patient’s preferences and overall health.

4. Resident Self Assessment Where do you fall on the continuum for each of the following? Please make an “X” on each line then date it: Practice-Based Learning and Improvement Novice Advanced Beginner CompetentProficientExpert 1.Appreciate the responsibility to assess and improve care collectively for a panel of patients. 2.Review an audit of a panel of patients using standardized, disease-specific, and evidence- based criteria. 3.Reflect on audit compared with local or national benchmarks and explore possible explanations for deficiencies, including doctor-related, system-related and patient-related factors. 4.Identify areas in resident’s own practice and local system that can be changed to improve the processes and outcomes of care. 5.Engage in a quality improvement intervention.

5. Resident Self Assessment Where do you fall on the continuum for each of the following? Please make an “X” on each line then date it: Interpersonal and Communication Skills Novice Advanced Beginner CompetentProficientExpert 1.Provide timely and comprehensive verbal and written communication to patients/advocates 2.Effectively use verbal and non-verbal skills to create rapport with patients/families and build therapeutic relationships. 3.Utilize patient-centered education strategies (like “Teach-Back) 4.Engage patients/advocates in shared decision- making for difficult, ambiguous or controversial scenarios. 5.Effectively communicate plan of care to all members of the health care team. 6.Follow-up on the results of diagnostic tests and studies appropriately in a timely fashion, and communicates the results to the patient and other members of the healthcare team as needed.

6. Resident Self Assessment Where do you fall on the continuum for each of the following? Please make an “X” on each line then date it: Professionalism Novice Advanced Beginner CompetentProficientExpert 1.Dress and behave appropriately. 2.Maintain appropriate professional relationships with patients, families and staff. 3.Ensure prompt completion of clinical, administrative and curricular tasks (including attendance at required conferences and team meetings). 4.Recognize and address personal, psychological and physical limitations that may affect professional performance. 5.Recognize the scope of his/her abilities and ask for supervision and assistance appropriately. 6.Serve as a professional role model for junior colleagues. 7.Recognize the need to assist colleagues in the provision of duties (team player).

7. Resident Self Assessment Where do you fall on the continuum for each of the following? Please make an “X” on each line then date it: Systems-Based Practice Novice Advanced Beginner CompetentProficientExpert 1. Demonstrate the ability to manage the patient-care improvement team by utilizing the skills and coordinating the activities of interprofessional team members as they work to improve care-delivery and clinical outcomes. 2. Reflect awareness of common socio- economic barriers that impact patient care. 3.Understand how cost-benefit analysis is applied to patient care (i.e. via principles of screening tests and the development of clinical guidelines). Identify the role of various health care stakeholders including providers, suppliers, financiers, purchasers and consumers and their varied impact on the cost of and access to health care. 4.Code outpatient visits and procedures appropriately.