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Preceptor Assessment of Student Performance
Student:
Last Name
   First Name
Preceptor:
Last Name
  First Name
Clerkship: Campus:
Rotation Dates:
Start Date
    End Date
 

Please rate the student using the following scale:

  • Exceptional (1): This student is an active self-directed learner whose performance in this area has been consistently outstanding. He/She performs at a level expected of first year residents or beyond.
  • Advanced (0.92): The student is proficient in this area and performs at a level expected of a yr 04 student.
  • Proficient/Competent (0.84): Performance/competency is within the range expected for students at this level and time of year.
  • Minimally meets expectations (0.75): Student's performance does not reflect anything more than the minimal level of competence.
  • Does not meet expectations (0.4): Student fails to meet the basic knowledge/skills expected for this level of education.
Patient Care/Clinical Knowledge
  Does not meet Expectations Minimally meets Expectations Proficient/ Competent Advanced Exceptional Not Observed or Applicable
1. Performance of problem-focused history and physical exam
2. Performance of complete history and physical exam
3. Understanding and prioritizing of patient problems
4. Logical formulation of primary and differential diagnoses
5. Prompt and clearly written notes, orders and other paperwork
6. Selection and interpretation of lab tests and results
7. Selection of an appropriate intervention/treatment plan
8. Identifies and addresses preventative medicine and patient education issues
9. Identifies and addresses family, cultural, and community issues
10. Ability to locate, understand and apply information from online and published medical research
 
Comments (Required Item):
 
Interpersonal Skills & Professionalism
  Does not meet Expectations Minimally meets Expectations Proficient/ Competent Advanced Exceptional Not Observed or Applicable
11. Reliability (punctuality, carries out responsibility in a timely manner, maintains patient confidentiality)
12. Identification of ethical issues
13. Active participation/strives for excellence in patient care
14. Communication skills and truthfulness
15. Develops respectful and sensitive relationships with patients, families and health care team members
16. Knowledge of limitations (seeks help when needed)
17. Acceptance and use of feedback/responds appropriately to criticism
18. Follows established rules, policies and professional standards
 
Comments (Required Item):
 
Specialty Items
  Does not meet Expectations Minimally meets Expectations Proficient/ Competent Advanced Exceptional Not Observed or Applicable
19. Performance of psychiatric exam (including mental status exam)
20. Assessment of patient competence
21. Assessment of patient safety
22. Ability to establish rapport with patient
 
Comments (Required Item):
 
Preceptor Subjective Grade %
 
 
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