Family Medicine/Women's Health/Pediatrics Preceptor End of Rotation Evaluation

Please put your name here:

Please write what rotation setting is your clinic in? (Women's health, Family medicine, or Pediatrics)

Please put the student's name here:

Date of completed evaluation:

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DD

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YYYY

Student Clinical Performance: Preventive Care Please rate the student's clinical performance in the following areas as it pertains to providing preventive care (based on their current level of education):

Excellent

Good

Average

Below Average

Poor

N/A

Patient Interviewing (CC, HPI, ROS, etc.)

Physical Examination

Diagnostic Skills (screening, imaging, lab, indications & contraindications, interpretation, patient education)

Diagnosis Formulation (Differential diagnosis & working diagnosis, evidence-based)

Clinical Interventions (Tx, Rx, patient education, evidence-based, follow-up, consultation/referral)

Health Maintenance

Cross-Cultural Skills (interpersonal skills related to cultural, ethnic, racial, socioeconomic, or other diverse backgrounds)

Excellent

Good

Average

Below Average

Poor

N/A

Patient Interviewing (CC, HPI, ROS, etc.)

Physical Examination

Diagnostic Skills (screening, imaging, lab, indications & contraindications, interpretation, patient education)

Diagnosis Formulation (Differential diagnosis & working diagnosis, evidence-based)

Clinical Interventions (Tx, Rx, patient education, evidence-based, follow-up, consultation/referral)

Health Maintenance

Cross-Cultural Skills (interpersonal skills related to cultural, ethnic, racial, socioeconomic, or other diverse backgrounds)

Clear selection

Student Clinical Performance: Acute Care Please rate the student's clinical performance in the following areas as it pertains to providing preventive care (based on their current level of education):

Excellent

Good

Average

Below Average

Poor

N/A

Patient Interviewing (CC, HPI, ROS, etc.)

Physical Examination

Diagnostic Skills (screening, imaging, lab, indications & contraindications, interpretation, patient education)

Diagnosis Formulation (Differential diagnosis & working diagnosis, evidence-based)

Clinical Interventions (Tx, Rx, patient education, evidence-based, follow-up, consultation/referral)

Health Maintenance

Cross-Cultural Skills (interpersonal skills related to cultural, ethnic, racial, socioeconomic, or other diverse backgrounds)

Excellent

Good

Average

Below Average

Poor

N/A

Patient Interviewing (CC, HPI, ROS, etc.)

Physical Examination

Diagnostic Skills (screening, imaging, lab, indications & contraindications, interpretation, patient education)

Diagnosis Formulation (Differential diagnosis & working diagnosis, evidence-based)

Clinical Interventions (Tx, Rx, patient education, evidence-based, follow-up, consultation/referral)

Health Maintenance

Cross-Cultural Skills (interpersonal skills related to cultural, ethnic, racial, socioeconomic, or other diverse backgrounds)

Clear selection

With regard to evaluating patients seeking preventive care or presenting with acute conditions, do you consider this student to be competent (based on their current level of education) in the following areas:

Competent

Inconsistent

Preventative Care: Constructing a broad differential diagnosis (Note: competency, for the purposes of this evaluation, is defined by the preceptor's level of confidence in the student's ability to construct a broad differential diagnosis.)

Acute Conditions: Constructing a broad differential diagnosis (Note: competency, for the purposes of this evaluation, is defined by the preceptor's level of confidence in the student's ability to construct a broad differential diagnosis.)

Preventive Care: Establishing a working diagnosis: (Note: competency, for the purposes of this evaluation, is defined by the preceptor's level of confidence in the student's ability to establish a working diagnosis)

Acute Conditions: Establishing a working diagnosis: (Note: competency, for the purposes of this evaluation, is defined by the preceptor's level of confidence in the student's ability to establish a working diagnosis)

Preventive Care: Developing an evidence-based, patient-centered plan (Note: competency, for the purposes of this evaluation, is defined by the preceptor's level of confidence in the student's ability to develop an evidence-based, patient-centered plan

Acute Conditions: Developing an evidence-based, patient-centered plan (Note: competency, for the purposes of this evaluation, is defined by the preceptor's level of confidence in the student's ability to develop an evidence-based, patient-centered plan

Competent

Inconsistent

Preventative Care: Constructing a broad differential diagnosis (Note: competency, for the purposes of this evaluation, is defined by the preceptor's level of confidence in the student's ability to construct a broad differential diagnosis.)

Acute Conditions: Constructing a broad differential diagnosis (Note: competency, for the purposes of this evaluation, is defined by the preceptor's level of confidence in the student's ability to construct a broad differential diagnosis.)

Preventive Care: Establishing a working diagnosis: (Note: competency, for the purposes of this evaluation, is defined by the preceptor's level of confidence in the student's ability to establish a working diagnosis)

Acute Conditions: Establishing a working diagnosis: (Note: competency, for the purposes of this evaluation, is defined by the preceptor's level of confidence in the student's ability to establish a working diagnosis)

Preventive Care: Developing an evidence-based, patient-centered plan (Note: competency, for the purposes of this evaluation, is defined by the preceptor's level of confidence in the student's ability to develop an evidence-based, patient-centered plan

Acute Conditions: Developing an evidence-based, patient-centered plan (Note: competency, for the purposes of this evaluation, is defined by the preceptor's level of confidence in the student's ability to develop an evidence-based, patient-centered plan

Clear selection

Professional Excellence: Rate the student's level of proficiency in each of the following professionalism attributes/skills.

Exemplary

Above Average

Adequate

Inconsistent

Unacceptable

Self-Confidence

Emotional Self-Control

Awareness of Limitations

Commitment to Learning

Reliability & Dependability

Accountability

Attitude

Empathy

Relationship Management

Attendance & Punctuality

Professional Appearance

Ethical Behavior

Clear selection

Please note the number of days the student was absent during this rotation when the student was scheduled to work (if applicable)? For any absence, please indicate the reason. If more than 3 absences, please notify the PA program via phone to ensure these absences have been excused.

Please comment about the student's strengths:

Please comment about opportunities for student improvement:

Based on their current level of education, do you feel this student has been adequately prepared and is progressing towards developing the competencies necessary to enter clinical PA practice?

Yes

No

Please comment on any areas this student may need additional time (how much) or exposure in order to meet outcomes for this rotation.

Do you have any additional comments or suggestions for improvements to the RMUoHP PA program's curriculum?