ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT
EVALUATION OF CLINICAL PERFORMANCE
1 = Cannot Perform Skills Independently
2 = Requires Some Assistance to Perform Skills
3 = Can Perform Skill Independently
NA = Not Applicable
Note: All medical staff will be privileged and credentialed according to the rules and regulations of that specific
healthcare organization. The medical staff of each department or service is responsible for peer review activities to
promote continuous improvement of the quality of patient care provided by the medical staff in all departments of the
healthcare organization. See your organization’s Medical Staff Bylaws and Rules and Regulations to define these
What educational programs have you developed and implemented for the 1 2 3 NA
facility staff? Patients?
What is your role in the treatment team and clinical problem solving 1 2 3 NA
What does the orientation program consist of for physicians new to the 1 2 3 NA
What key components do you look at when assisting with the formulation 1 2 3 NA
of the budget for the facility?
What is your role in the facility's continuous quality improvement program? 1 2 3 NA
How do you stay current with the changing regulations, standards and 1 2 3 NA
laws affecting the facility?
What is the restraint policy? 1 2 3 NA
What is your role in an emergency situation? 1 2 3 NA
Demonstrates a strong working relationship with the Program Director, 1 2 3 NA
facility administration, medical staff, personnel and the community.
Demonstrates a commitment to performance improvement and CQI 1 2 3 NA
Demonstrates knowledge of local, state, federal regulations and JCAHO 1 2 3 NA
Maintains professional growth and development through seminars, 1 2 3 NA
conferences and professional affiliations.
ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - SOVEREIGN HEALTH OF
CALIFORNIA MEDICAL DIRECTOR (continued)
Demonstrates competency in the knowledge of the delivery of patient care 1 2 3 NA
in an environment that optimizes patient safety and reduces the likelihood
of medical/health care errors.
Demonstrates the knowledge of proper identification and reporting of 1 2 3 NA
medical/health care errors. Protects the patient in the event of a
medical/health care error and, as appropriate, assists in medical/health
care error resolution.
Unit/Facility Environment - Able to locate and/or demonstrate knowledge
Facility directory 1 2 3 NA
Physician directory 1 2 3 NA
Telephone system 1 2 3 NA
Paging/beeper system 1 2 3 NA
Fax machine 1 2 3 NA
Alarms 1 2 3 NA
Extinguishers 1 2 3 NA