Family Medicine Clerkship Student Evaluation
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2FAMILY MEDICINE CLERKSHIP STUDENT EVALUATION
Student _______________________________________ Site_______________________________
Evaluator _____________________________________ Dates _____________________________
Use the following scale to rate the student on the 16 listed areas AND the student’s overall performance
Unacceptable
Marginal Performance
Typical Performance
Superior Performance
Honors
(Needs improvement)
(Expected for UVA Student)
(Top 20%)
(Top5%)
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2
3
4
5
Designations of “Unacceptable”, “Marginal” and “Honors” require supporting evidence in the required narrative comments
Evaluation:
(Circle appropriate rating)
(NA/CA=not applicable; cannot assess)
1. Clinical knowledge base
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2
3
4
5
NA/CA
Depth and integration of pertinent clinical and basic science knowledge
2. Ability to engage and
1
2
3
4
5
NA/CA
communicate with patients
Ability to initiate communications, listen effectively, and convey information to patients and families
3. Ability to perform a focused
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2
3
4
5
NA/CA
and time-efficient history
Completeness of history (appropriate for the clinical situation); use of logical approach; asks follow-up questions
4.
Ability to perform a pertinent
1
2
3
4
5
NA/CA
physical examination
Completeness, accuracy, ability to direct exam to patient’s problems. Ability to elicit/interpret findings
5.
Ability to select, justify and
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2
3
4
5
NA/CA
interpret basic diagnostic studies
Selects appropriate diagnostic studies, including lab tests. Interprets results
6. Ability to present
1
2
3
4
5
NA/CA
information orally
Presents in a complete, accurate, and organized fashion. Gives appropriate detail for the clinical setting
7. Ability to keep appropriate
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2
3
4
5
NA/CA
written clinical records
Completeness, accuracy, organization. Appropriate detail given.
8. Ability to generate and
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2
3
4
5
NA/CA
refine an appropriate
diagnosis/differential diagnosis
Uses patient information to generate appropriate diagnosis/differential diagnosis.
9.
Ability to develop an immediate
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2
3
4
5
NA/CA
and appropriate plan of care
Uses clinical and laboratory information to develop a diagnostic, clinical care, and treatment plan
10. Ability to prognose illness
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2
3
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5
NA/CA
and plan for follow-up
Understands implications of patient’s illness, including prognosis, and can plan for follow-up
11. Technical/procedural skills
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2
3
4
5
NA/CA
Demonstrates technical/procedural skills appropriate for this clerkship and the student’s stage of training.
12. Ability to access & apply
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2
3
4
5
NA/CA
literature resources
Identifies, accesses, and utilizes current medical information in the care of patients. Shares information with colleagues.
Student Evaluation Form, page 2
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