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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

    Comments: