MS4-AdvYr-Eval-form-2015-blank.doc - SUNY Downstate – College of Medicine EM EVALUATION FORM Student_Date/Shift/Location_Evaluator of Patients Not

MS4-AdvYr-Eval-form-2015-blank.doc - SUNY Downstate –...

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SUNY Downstate – College of Medicine EM EVALUATION FORM Student: ___________________________Date/Shift/Location: _____________________________Evaluator: __________________ # of Patients____ Not observed Unacceptable [REQUIRES COMMENT] At expected level of MS3 At Expected Level of MS4 Above Expectation (Within top 25%) Outstanding (Top 10-15%) Approaching Level of Intern I. PATIENT CARE AND CLINICAL REASONING ( circle appropriate number and descriptor) A. History Taking 0 Not observed 1 Incomplete or unfocused Relevant information missing 2 Accurate basic history but missing pertinent details. Unclear chronology ( reported by patient); Not age appropriate 3- 3 3+ Accurate, focused hypothesis-driven relevant data. Well-organized with clear chronology. Needs prompting to seek data from additional sources if needed. Age appropriate 4 5 Able to obtain history at the pace expected of interns. Performs and communicates a reliable, comprehensive history. Independently seeks data from additional sources if needed. B. Physical Exam 0 Not observed 1 Somewhat inaccurate or incomplete. Incorrect technique 2 Performs a basic exam without focus; Misses pertinent findings. Major age appropriate components correct Technique with minor errors 3- 3 3+ Complete and age appropriate exam. Correct technique Usually interprets exam findings appropriately. Usually identifies findings relevant to chief compliant. 4 5 Can perform exam at the pace expected of interns. Consistently performs, interprets, communicates a comprehensive exam and collects relevant physical findings for the chief compliant. C. Diagnosis, Clinical Reasoning and Testing 0 Not observed 1 Reports data without analysis. Limited differential 2 Reasonable differential diagnosis with prioritization. Only interprets common tests and imaging reports. 3- 3 3+ Integrates all patient data in assessment. Accurate, prioritized differential justified by clinical data Assesses patients at half the pace expected of an intern 4 5 Can easily assess patients at more than half the pace of an intern. Extensive, prioritized differential. Determines the necessity of diagnostic studies. D. Patient Management 0 Not observed 1 Does not formulate basic short term plans; Gaps in understanding of management plans.
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  • Spring '14
  • JanetH.Keefer

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