Osteopathic Medical Student Clinical Performance …com.tu.edu/academics/Evaluation Form CPE...
Transcript of Osteopathic Medical Student Clinical Performance …com.tu.edu/academics/Evaluation Form CPE...
Osteopathic Medical Student Clinical Performance Evaluation 2017 – 2018
Student: Preceptor: Course # Site: Clerkship Dates: Specialty:
Dean’s Letter Summary (Please note all comments included in this box or the reverse page, unless otherwise labeled, will be put into the students Dean’s Letter verbatim)
*Any additional comments not to be included in the Dean’s Letter, please use reverse side of this form or a separate correspondence and label as such.
Overall do you feel the student passed the rotation? Would you recommend that this student receive Honors for this clerkship? Did student miss any dates or call shifts on this rotation?
Yes ☐ No ☐ Comments____________
Yes ☐ No ☐ Comments____________
Yes ☐ No ☐ Comments____________
AOA Competencies
Student’s performance by the rotation’s end (Please check one box for each section)
Fails Expectation
Misses Expectation
Meet Expectation
Exceeds Expectation
Masters Expectation
No Basis for
Opinion
Professionalism Thestudentparticipatesandperformsindidacticsessions □ □ □ □ □ □
PatientCare
The student is able to perform or explain procedures as expected forcurrentleveloftraining □ □ □ □ □ □The student is able to performH&P as expected for current level oftraining □ □ □ □ □ □
OsteopathicPrinciplesandPractice
Thestudentdemonstratesappropriateuseofosteopathicmanipulativemedicine □ □ □ □ □ □Thestudentappliesosteopathicprinciplestodiagnosisandtreatmentofpatients □ □ □ □ □ □
Patientcare
Thestudentdisplaysevidenceofongoingawarenessofthepatient’sconditionandprogress □ □ □ □ □ □Thestudentisdiligentatcarryingoutplansandcommunicatingchangeswiththepatient □ □ □ □ □ □
MedicalKnowledge
Thestudentisknowledgeableaboutthepatient’sconditionanddifferentialdiagnosis □ □ □ □ □ □Thestudentshowssignsofindependentlearning □ □ □ □ □ □
PracticeBasedLearning&Improvement
The student showssignsof significant learningtakingplaceduring therotation □ □ □ □ □ □The student displays understanding of the use of evidence in clinicaldecisionmaking □ □ □ □ □ □The student refers to bibliographic resourceswhile discussing clinicaltopics □ □ □ □ □ □
Professionalism
Thestudenthasagoodworkethic □ □ □ □ □ □The student comported him/herself in a professional and appropriatemanner □ □ □ □ □ □Thestudentisrespectfultowardpeers,co‐workers,attendingandresidentphysicians,patientsandfamilies □ □ □ □ □ □
Interpersonal&Communication
Skills
The student is able to communicate clearly and effectively to patients,familiesandco‐workers □ □ □ □ □ □Thestudentisabletoperformcasepresentationsinalucidandfocusedmanner □ □ □ □ □ □
SystemsBasedPractice
Thestudentunderstandsandbehavesappropriately intheirrole inthesystemofmedicalcare □ □ □ □ □ □Thestudentisabletofigureouthowtoaccomplishtasksinpatientcare,atalevelcommensuratewiththeirdegreeofadvancement □ □ □ □ □ □
Preceptor’s Signature Date: Evaluation Reviewed with Student? Yes No Student’s Signature
*Please provide a copy of this evaluation to the student after review.
Mail form to: Office of Clinical Education Touro University‐CA College of Osteopathic Medicine, 1310 Club Drive, Vallejo, CA 94592; Or Email to: [email protected]; Fax Not Recommended
If you have any questions, please contact Kimberly Black, phone (707-638-5378)
Explanation of the Clinical Preceptor evaluation form
We appreciate the time that is required to evaluate these competencies. We ask that you allot a brief amount of time
available to meet with the students in the middle and the end of the rotation in order to apprise them of their progress
and performance. Please contact the Clinical Education Department with any concerns regarding individual student
progress.
Clinical Education Department contact information:
Comments entered here will be transcribed verbatim into the Medical Student Performance Evaluation (MSPE, or Dean’s Letter). We appreciate
your effort to comment in detail. Preceptor commentary is the single most important element of the MSPE.
Each subcategory of
the AOA
competencies is
evaluated on a 5
point Likert scale.
Each point is
assigned a percent
value (from 50% for
“Fails Expectations”
to 100% for
“Masters
Expectations”). It is
from this that
grades for all
electives and Year 4
rotations are
derived.
Please check this box to confirm
that the student has passed, or not
passed the overall experience.
Check the “No Bases for
Opinion” boxes if you did not
have the opportunity to
observe the categories during
the rotation.
In order for us to
process this
evaluation, please
make sure to provide
student and rotation
information including
course number,
dates, specialty and
preceptor’s name.
Do not forget to sign this document to validate it, and to email it
to our course coordinator Mon Saepharn.