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Prior to the end of your rotation(s) on our service, please ask one of the residents who knows you well to complete this brief summative assessment. Thank you!
1.
0-Name of students medical school..........
2.
0-Current year (e.g., 2006)..........
3.
0-Current month (e.g., March)........
4.
0-Student's last name.......................
5.
0-Student's first name......................
6.
1-Wrote up cases & progress notes for resident to review?.....
a. yes     b. no
7.
1-Assessments(DDx)showed clin. reason. based on physiology?...
a. yes     b. no
8.
1-Plan showed clin.judgment based on risks, benefits, costs?..
a. yes     b. no
9.
2-Was observed by my resident performing a history?...........
a. yes     b. no
10.
2-....that used an inquiry strategy which was open-ended?.....
a. yes     b. no
11.
2-....that was empathetic?....................................
a. yes     b. no
12.
2-....that showed cultural sensitivity (explanatory model)?...
a. yes     b. no
13.
2-Student was recorded during a Hx with a standardized pat?...
a. yes     b. no
14.
2-Video of standardized pat. interview reviewed with student?.
a. yes     b. no
15.
3-Observed by resident performing physical?...................
a. yes     b. no
16.
3-How many times was student observed performing phys. exam?..
17.
3-Progress Notes reviewed by resident were appropriate?.......
a. yes     b. no
18.
4-Was accountable to attend conferences, arrive on time?......
a. yes     b. no
19.
4-Student maintained patient confidentiality?.................
a. yes     b. no
20.
4-Student dressed professionally?.............................
a. yes     b. no
21.
5-Student generated focused clinical questions & looked up?...
a. yes     b. no
22.
5-Student reflected on own performance, reviewed it with res?.
a. yes     b. no
23.
6-SHx in H&P was useful for discharge & system planning?......
a. yes     b. no
24.
6-Student completed some post-discharge “virtual” housecalls?.
a. yes     b. no
25.
Overall performance on a scale of 1-9 as well as comments:....
26.
PGY level & name of resident who filled out this form (remember to click on 'SUBMIT', below, when done. Thank you!