Clinical Skills Assessment - M3 Students

Evaluator:

 

 

Subject:

 

Status:

 

 

Status:

 

Rotation:

 

 

Rotation:

 

Employer:

 

 

Employer:

 

 

 

Complete a brief checklist of skills using either correct or remediated. The main objective is to identify where students have difficulties with certain aspects of the physical examination and remediate those problems.



History:

 

 

 

Patient rapport

  

Correct   
 

Remediated   
 

N/A

 

 

 

 

 

 

Appropriate questioning and train of thought in information gathering

  

Correct   
 

Remediated   
 

N/A

 

 

 

Physical Examination - Neck

 

 

Properly palpates all major lymph node regions

  

Correct   
 

Remediated   
 

N/A

 

 

 

 

 

 

Properly palpates the thyroid

  

Correct   
 

Remediated   
 

N/A

 

 

 

 

 

 

Properly palpates and auscultates carotid pulse

  

Correct   
 

Remediated   
 

N/A

 

 

 

 

 

 

Properly checks jugular venous pulsations

  

Correct   
 

Remediated   
 

N/A

 

 

 

Physical Examination - Cardiac

 

 

Palpates for PMI

  

Correct   
 

Remediated   
 

N/A

 

 

 

 

 

 

Auscultates at all 4 listening posts (bell and diaphragm)

  

Correct   
 

Remediated   
 

N/A

 

 

 

Physical Examination - Respiratory

 

 

Percussion

  

Correct   
 

Remediated   
 

N/A

 

 

 

 

 

 

Auscultation

  

Correct   
 

Remediated   
 

N/A

 

 

 

Physical Examination - Abdominal

 

 

Performs auscultation first

  

Correct   
 

Remediated   
 

N/A

 

 

 

 

 

 

Palpation of liver and spleen and aorta

  

Correct   
 

Remediated   
 

N/A

 

 

 

 

 

 

Palpation of Abdomen

  

Correct   
 

Remediated   
 

N/A

 

 

 

 

 

 

Percussion of liver diameter

  

Correct   
 

Remediated   
 

N/A

 

 

 

Physical Examination - Extremities

 

 

Palpation for edema

  

Correct   
 

Remediated   
 

N/A

 

 

 

 

 

 

Palpation of poplitial, DP and PT pulses

  

Correct   
 

Remediated   
 

N/A

 

 

 

Physical Examination - Neurological

 

 

Cranial nerves (II-XII)

  

Correct   
 

Remediated   
 

N/A

 

 

 

 

 

 

Cerebellar Function

  

Correct   
 

Remediated   
 

N/A

 

 

 

 

 

 

Reflexes, DTR, Babinski

  

Correct   
 

Remediated   
 

N/A

 

 

 

 

 

 

Strength (proximal, distal, fix, drift)

  

Correct   
 

Remediated   
 

N/A

 

 

 

 

 

 

Sensation (light touch, vibratory, sharp/dull)

  

Correct   
 

Remediated   
 

N/A

 

 

 

Overall:

 

 

Grade:

  

Pass    
 

Remediation Planned   
 

N/A

 

 

 

a)      Comments:


 

 

 

 

 

Mid Term Evaluation of M3s

Evaluator:

 

 

Subject:

 

Status:

 

 

Status:

 

Rotation:

 

 

Rotation:

 

Employer:

 

 

Employer:

 

 

 

The following should be completed by the residents and attending physician. This evaluation is not intended to be a grade nor will it be included in the student's permanent file. It will service 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:

 

 

 

Evaluation skills

  

Comment   

 

 

 

 

 

 

Clinical reasoning

  

Comment   

 

 

 

 

 

 

Quality of presentations

  

Comment   

 

 

 

 

 

 

Work Habits

  

Comment   

 

 

 

 

 

 

Other

  

Comment   

 

 

 

 

 

Jr Inpatient Rotation Core Objectives Evaluation Form

Evaluator:

 

 

Subject:

 

Status:

 

 

Status:

 

Rotation:

 

 

Rotation:

 

Employer:

 

 

Employer:

 

 

 

Complete this evaluation after meeting with the resident to discuss the student's performance. Due weight should be given to whether or not the student has had previous clerkships in applying the criteria. Distribution of student evaluations should fall under the following guidelines: 5% Unsatisfactory, 10% Marginal – Needs Improvement, 45% Satisfactory, 25% Above Average, 15% Superior



RATING GUIDELINE

 

 

 

RATING GUIDELINES FOR DISTRIBUTION OF SCORES - DO NOT CHANGE FROM N/A

  

5% Unsatisfactory   
 

10% Marginal Needs Improvement   
 

45% Satisfactory   
 

25% Above Average   
 

10% Superior   
 

N/A

 

 

 

PATIENT CARE

 

 

Communicates with patients, family and co-workers

  

Unsatisfactory    
 

Marginal Needs Improvement   
 

Satisfactory    
 

Above Average    
 

Superior    
 

N/A

 

 

 

 

 

 

Records and presents information in a concise and organized manner

  

Unsatisfactory    
 

Marginal Needs Improvement   
 

Satisfactory    
 

Above Average    
 

Superior    
 

N/A

 

 

 

 

 

 

Conducts the medical interview and obtains a medical history

  

Unsatisfactory    
 

Marginal Needs Improvement   
 

Satisfactory    
 

Above Average    
 

Superior    
 

N/A

 

 

 

 

 

 

Performs an appropriate physical examination

  

Unsatisfactory    
 

Marginal Needs Improvement   
 

Satisfactory    
 

Above Average    
 

Superior    
 

N/A

 

 

 

 

 

 

 

 

Accuracy of data collection

  

Unsatisfactory    
 

Marginal Needs Improvement   
 

Satisfactory    
 

Above Average    
 

Superior    
 

N/A

 

 

 

 

 

 

Demonstrates effective clinical reasoning and judgment

  

Unsatisfactory    
 

Marginal Needs Improvement   
 

Satisfactory    
 

Above Average    
 

Superior    
 

N/A

 

 

 

MEDICAL KNOWLEDGE

 

 

General Medical knowledge

  

Unsatisfactory    
 

Marginal Needs Improvement   
 

Satisfactory    
 

Above Average    
 

Superior    
 

N/A

 

 

 

PRACTICE-BASED LEARNING AND IMPROVEMENT

 

 

Demonstrates self-directed learning skills

  

Unsatisfactory    
 

Marginal Needs Improvement   
 

Satisfactory    
 

Above Average    
 

Superior    
 

N/A

 

 

 

 

 

 

Participates on rounds, displays enthusiasm and effort

  

Unsatisfactory    
 

Marginal Needs Improvement   
 

Satisfactory    
 

Above Average    
 

Superior    
 

N/A

 

 

 

 

INTERPERSONAL AND COMMUNICATION SKILLS

 

 

Functions as a member of the healthcare team

  

Unsatisfactory    
 

Marginal Needs Improvement   
 

Satisfactory    
 

Above Average    
 

Superior    
 

N/A

 

 

 

 

 

 

Reliability and dependability

  

Unsatisfactory    
 

Marginal Needs Improvement   
 

Satisfactory    
 

Above Average    
 

Superior    
 

N/A

 

 

 

PROFESSIONALISM

 

 

Demonstrates sensitivity and responsiveness to patients' culture, age gender and disabilities

  

Unsatisfactory    
 

Marginal Needs Improvement   
 

Satisfactory    
 

Above Average    
 

Superior    
 

N/A

 

 

 

 

 

 

Demonstrates respect, compassion, and integrity in the care of patients

  

Unsatisfactory    
 

Marginal Needs Improvement   
 

Satisfactory    
 

Above Average    
 

Superior    
 

N/A

 

 

 

ROTATION EVALUATION:

 

 

Outstanding: Exceptional knowledge of medical effort and skills. (Represents top 10% of students in the clerkship).

  

Outstanding   
 

N/A

 

 

 

 

 

 

Pass: Adequate level of knowledge, effort and skills

  

Pass    
 

N/A

 

 

 

 

 

 

Fail: Has inadequate knowledge, effort or skills.

  

Fail   
 

N/A

 

 

 

 

 

 

Exit Interview: The attending physician is ultimately responsible for completing this evaluation and assigning a grade.

  

Yes   
 

No   
 

N/A

 

 

 

ROTATION COMMENTS ARE REQUIRED

 

 

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