UWSMPH Clinical Clerkship Evaluation of Medical Students
832-813 RADIOLOGY REQUIRED COURSE
Student:
_______________________ Dates of Rotation:
1. Evaluator Role
Clerkship Director
X
Attending
____________________________________
Mentor
Advanced
Resident
Competent
Other
Needs
Improvement
Unacceptable
Not Evaluated
1. Generates differential diagnosis
2. Exhibits knowledge of diseases and
pathophysiology
3. Oral presentation skills
Competent
4.
5.
6.
7.
Needs
Improvement
Unacceptable
Not Evaluated
X
X
X
X
Respect/Compassion for Others
Response to Feedback
Accountability
Appearance
8. Exam Grade ________________
9. Please comment on this student's overall performance. These comments will be included VERBATIM in the medical
Student performance Evaluation (MSPE, formerly known as the Dean's letter).
10. I have concerns about this student's performance. The Dean for Students should review his/her record
____Yes __X___No
11. I have reviewed this evaluation with the student.
____Yes __X___No
FINAL COURSE GRADE
GPA Grade Set
A
 AB
B
 BC
C
F
Signature of Evaluator: _____________________________________________________
Date: ___________________