Assessment of Clinical Skills By Direct Observation Medicine Clerkship

Student’s Name: ___________________ Date of Assessment:__________________

Evaluator’s Name: __________________ Clinical Site:________________________

I. Based on direct observation of all or part of a medical interview or physical examination, comment on student performance. Be specific about what, where, how, and when, what went well, and what could be improved. Next step recommended for this student:

II. Based on this interaction, the following aspects of clinical competence were also evaluated:

Check all that apply: Comments:

( ) Diagnostic Decision Making

( ) Case Presentation

( ) History and Physical Examination

( ) Communication with Patients and Colleagues

( ) Test Interpretation

( ) Therapeutic Decision Making

( ) Bioethics of Care

( ) Self-directed Learning

( ) Prevention

( ) Coordination of Care and Teamwork

( ) Basic Procedures

( ) Geriatric Care

III. With respect to the above assessed skill(s), this student

(Check One):

( ) Is Competent ( ) Needs Improvement

IV. Feedback to student: Date Done or Date Planned: _____________

Comments:

Evaluator’s Signature:________________________________________ Date: ________________

Check: ( ) Attending ( ) Resident

Student’s Signature: ________________________________________ Date: ________________