DEPARTMENT OF INTERNAL MEDICINE
Medicine Clerkships
Mid Rotation Feedback/Formative Evaluation
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Rotation Dates |
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Service Name |
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The following should be completed by the students, residents and attending physician. The student should assess his or her progress made in development of clinical skills and share this with the faculty. It will serve to provide students with candid, constructive feedback concerning their performance on the clerkship to date. The comments should address the strengths, weaknesses and provide plans for improvement for the students. We encourage residents and attendings to review the evaluation with the students.
Comments/Concerns (examples in parentheses below):
Evaluation skills
Student Comments
(rapport with patients, respect for patients, report clinical data in organized
manner):
Faculty Comments:
Clinical reasoning
Student Comments
(Interpret clinical data, prioritize problem list,
devise appropriate management strategy):
Faculty
Comments:
Quality of presentations
Student Comments
(Organized presentations and differential diagnoses, organized and complete
daily notes and H & Ps):
Faculty
Comments
Work habits
Student Comments
(Works well with others, reliable, cooperates with team, professional conduct):
Faculty Comments:
Other (Strategy for continued development)
Signatures
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Attending MD (Print Name) Resident (Print Name)
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Student (Print Name) Date