Scholarship Academic Progress Form

To be completed by a professor, mentor or attending physician

* All fields are required

Please use the following rating scale to answer the questions below:

(1) Unacceptable
Performance is below the level expected for the applicant's academic level and major deficiencies are noted with serious concerns.
(2) Marginal
Performance is below thelevel expected for the applicant's academic level and additional work is recommended.
(3) Very Good
Performance is at the level expected for the applicant's academic level with some deficiencies.
(4) Excellent
Performance is above average for the applicant's academic level with minor deficiencies.
(5) Outstanding
Performance is exceptional (top 10%) and the applicant displays skills for exceeding their academic level.

*Medical Knowledge: breadth and depth of knowledge commensurate with the level of education / training

*Clinical Skills: clinical reasoning, history and physical and examination skills

UnacceptableMarginalVery GoodExcellentOutstanding

*Communication Skills: written and oral presentation skills, patient communication

UnacceptableMarginalVery GoodExcellentOutstanding

*Professionalism: integrity, reliability, ability to work with a team, adherence to ethical principles

UnacceptableMarginalVery GoodExcellentOutstanding

*Empathy or ability to show compassion towards others

UnacceptableMarginalVery GoodExcellentOutstanding

*Commitment to academic and professional excellence

UnacceptableMarginalVery GoodExcellentOutstanding


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Houston's Black Female Physicians
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