CREIGHTON UNIVERSITY

DEPARTMENT OF INTERNAL MEDICINE

JUNIOR CLERKSHIP Required Elements EVALUATION FORM

 

 

Student:

Services:  

 

 

 

 

 

 

Rotation Dates:    

 

 

 

 

 

Part I

 

Ratings

Unsatisfactory

Marginal

Satisfactory

Above

Average

Superior

GENERAL CLINICAL COMPETENCIES*

 

 

 

 

 

1.  Patient Care

 

 

 

 

 

2.  Medical Knowledge

 

 

 

 

 

3.  Practice-based learning and improvement

 

 

 

 

 

4.  Interpersonal skills

 

 

 

 

 

5.  Professionalism

 

 

 

 

 
                   

 

                                                Part II

                           

CLERKSHIP SPECIFIC CRITERIA:

Pass

Fail

1.             3 On Call H & P’s                 (Submitted and Approved)

 

 

2.             H & P Log                              (Minimum of 3 H & P/Week)

 

 

3.             Attendance:

 

 

 

                                Rounds                  (100% unless excused by Staff)

 

 

                                Lectures                 (100% unless excused by Chief Residents)

 

 

                                Conferences           (70% of 24 Required Department Conferences)

 

 

Student Morning Report  (100% unless excused by Chief Residents)

 

 

4.             EKG Interpretation Quiz     (Post Test)

 

 

5.           Grand Rounds Presentation

 

 

 

            First Month Grade:               ___________

            Second Month Grade:          ___________

            Shelf Test Grade:                  ___________

 

 

 

            FINAL GRADE __________________________

 

 

                Signature ________________________________________________

                                        Clerkship Director

 

 

            **Overall grade reflects performance, not necessarily an average of category marks.

 

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