OBG 430 Medical Student Clinical Evaluation
Student ________________________ Site: ____________________________ Evaluator: _____________________
If assessment is behavior-based, accurately describe where the learner fits in the progression. Procedures, specialty knowledge
will be linked to graduation competency webpage. Directions: Select ONE descriptor that most accurately reflects the student’s
performance. Select the “Unable to Assess” option only if you did not have the opportunity to adequately observe a particular part of the
student’s performance.
Patient Care: History Taking – Obtains problem-focused, organized history that is systematic and appropriate to
setting/discipline
Unable to Assess
Does not meet expectations
Meets expectations
Exceeds expectations
Misses critical information due to
technique (premature closure,
missing nonverbal cues, not
checking accuracy); disorganized
and inefficient
Usually establishes rapport and a
therapeutic relationship (openended questions, nonverbal
behaviors, checks for accuracy);
organized and efficient with
occasional prompting needed
Always is patient-centered, problem
focused, organized and culturally
sensitive; listens actively and is
empathic
Comments:
Patient Care: Physical Exam – Performs exam components appropriate for patient and setting
Unable to Assess
Does not meet expectations
Performs incomplete exams or has
difficulty selecting parts to perform,
uses incorrect technique; not
responsive to patient concerns
Meets expectations
Exceeds expectations
Usually selects and performs exam
Consistently includes pertinent
components appropriate for the
exam components, with correct
patient and setting; technique
technique, appropriate for the
correct and organized; responsive patient and setting; is organized and
to patient needs
efficient; very responsive to patient
needs
Comments:
Patient Care: Diagnosis and Management – Synthesizes data to create prioritized differential diagnosis
Unable to Assess
Does not meet expectations
Meets expectations
Exceeds expectations
Does not generate a differential
Generates prioritized differential
Generates prioritized differential
diagnosis, needs assistance in
diagnosis based on data; can
diagnosis with articulation of
interpreting how data/findings relate usually correctly identify most likely
reasoning; can correctly identify
to the differential diagnosis; Plans diagnosis; generates initial plan that
most likely diagnosis most of the
are not complete nor prioritized
is complete and prioritized with
time; generates plans that are
assistance
reasonable, prioritized, and efficient
Comments:
Patient Care: Procedures - Explains indications/contraindications, technique and complications for common procedures,
and can perform basic procedures with minimal assistance under supervision
Unable to
Assess
Exceeds expectations
Does not meet expectations
Meets expectations
Consistently explains
Requires prompting and assistance to
Explains risks/benefits/indications/
risks/benefits/indications/
explain risks/benefits/indications and contraindications and technique of basic contraindications and technique of basic
contraindications for basic procedures; procedures with some assistance under procedures under supervision but with
requires very close supervision and
supervision; demonstrates skill and
no assistance; demonstrates skill and
coaching to perform procedures the
ability to perform basic procedures with ability to perform basic procedures with
student has performed before
some assistance
minimal assistance
Comments:
Patient Care: Documentation and Presentation – Notes and presentations are organized, timely, relevant and patientcentered
Unable to Assess
Does not meet expectations
Meets expectations
Exceeds expectations
Notes and/or oral presentations are
disorganized and may be
incomplete or include extraneous or
inaccurate information; reads notes
when presenting with no eye
contact
Includes focused, relevant details
with little extraneous information;
accurate; presentation relies on
notes for some information but
keeps team engaged with eye
contact
Includes focused, relevant details,
no extraneous information,
integrates evidence-based
information; succinct presentations
show command of data with minimal
use of notes
Comments:
Knowledge: Fundamental Knowledge and Clinical Reasoning – utilizes solid broad-based knowledge regarding
clinical syndromes and disease to manage clinical problems
Unable to Assess
Does not meet expectations
Meets expectations
Exceeds expectations
Demonstrates limited knowledge
Demonstrates solid, broad-based
Applies extensive scientific
regarding syndromes and disease;
knowledge regarding clinical
knowledge to problem-solving in a
needs assistance to integrate
syndromes and disease; can apply
dynamic environment and
scientific knowledge, patient-specific scientific knowledge and population- addresses core clinical problems for
data, and population-based factors
based factors to gather and
the discipline without prompting;
to interpret data and manage clinical accurately interpret patient-specific
can apply knowledge to solve
problems; may make common
data and to manage clinical
complex clinical problems; monitors
cognitive errors such as limited
problems with minimal assistance;
and avoids common cognitive
differential diagnoses, choosing
avoids common cognitive errors in
errors in patient care
familiar diagnoses over rare ones, or
patient care
premature closure on patient workup
Comments:
Interpersonal and Communication Skills: Collaborative Relationships – Able to form effective therapeutic
relationship with patients and families and communicates well with other members of an interdisciplinary team
Unable to Assess
Does not meet expectations
Meets expectations
Does not consistently respond to Consistently responds to patients with
patients with empathy and
empathy, respect and compassion;
compassion or does not show
seeks to understand patient needs
patients respect; has difficulty with and sociocultural norms; consistently
understanding the importance of
respectful to peers & colleagues,
professional relationships with
appreciates the contributions of
peers, colleagues, and teachers
people in a multidisciplinary team
Exceeds expectations
Consistently responds to verbal and
non-verbal cues with empathy,
compassion, respect, even in
challenging situations; astute in
discerning needs and sociocultural
norms and integrates patient's
perspective, "interpersonally
engaged"; able to work effectively in a
multidisciplinary team
Comments:
Interpersonal and Communication Skills: Information Sharing – Information communicated to patients and families is
consistently accurate and understandable
Unable to Assess
Does not meet expectations
Meets expectations
Exceeds expectations
Gives incomplete or inaccurate
information using language and
jargon not familiar to patients or
their families; inconsistent attention
to patient/family needs and
understanding, with pacing either
too fast or too slow
Usually gives accurate and complete
information in language
understandable to the patient and
family; usually confirms
understanding using pacing
appropriate to patient/family needs
Consistently gives accurate and
complete information in language
understandable to the patient and
family; consistently confirms
understanding using pacing
appropriate to patient/family needs;
encourages patient/family
collaboration in treatment plan
Comments:
Professionalism: Altruism and Humanism – Recognizes primacy of patient needs above student needs
Unable to Assess
Comments:
Does not meet expectations
Meets expectations
Exceeds expectations
Does not recognize conflicts
between the needs of self-versus
the needs of patients
Recognizes conflicts between selfneeds and patient-needs;
consistently prioritizes needs of
patients above own needs
Consistently applies strategies to
address conflicts between patient
needs and those of self/others;
teaches and models responsible
behavior
Professionalism: Cultural Competence – Develops rapport and effectively communicates with individuals of various
professions, cultures, languages, and beliefs
Unable to Assess
Does not meet expectations
Meets expectations
Exceeds expectations
Does not work effectively with
patients from diverse backgrounds,
including not attempting to obtain
healthcare interpreter in appropriate
situations; does not work
collaboratively with health care team
members
Can incorporate patients' cultural
beliefs, practices, and supports into
assessment and management plan;
accesses healthcare interpreters
(hospital or phone) in appropriate
situations without prompting; works
collaboratively with health care team
members
Applies knowledge of healthcare
disparities and sociocultural factors
to care for patients from various
backgrounds; effective use of
healthcare interpreters in actual
clinical care; able to work
collaboratively and effectively with
health care team members
Comments:
Professionalism: Accountability – Demonstrates "ownership" of and accountability to patient care and learning
activities
Unable to Assess
Does not meet expectations
Meets expectations
Exceeds expectations
Requires reminders to participate in
appropriate day-to-day care
activities
Demonstrates individual ownership
and accountability to patient care
and personal learning needs by
responsible participation without
reminding; timely, active, and
engaged in group activities
Consistently demonstrates a high
level of accountability through
responsible participation and
sometimes going beyond
expectations in all activities
Comments:
Systems Based Practice: Health Care Delivery System – Understands how the healthcare system functions and
integrates with interprofessional healthcare providers, and advocates for patients within the system
Unable to Assess
Comments:
Does not meet expectations
Meets expectations
Exceeds expectations
Unable to understand the
complexity and importance of
working within the health system
to achieve optimal patient care
Engages in advocacy for patients
within the system regarding
resources, services, and access,
including discharge planning and
communicating with other providers
Takes initiative to work within the
system to advocate for patients
regarding resources, services, and
access, including discharge planning,
consultants and communicating with
other providers
Life-long Learning (formerly Practice-based learning): Critical reflection and self-improvement – Engages in selfdirected learning based on feedback and self-reflection
Unable to Assess
Does not meet expectations
Meets expectations
Requires repeated feedback about Actively seeks and responds readily
performance; does not self-initiate
to feedback; engages in additional
responsibilities to advance education responsibilities to advance learning
Exceeds expectations
Uses feedback and past experience
to inform and develop plan to
address own learning needs; selfinitiates additional responsibilities to
advance education
Comments:
Life-long Learning: Evidence-Based Medicine – Identifies, appraises, and applies scientific evidence to patient car
Unable to Assess
Does not meet expectations
Does not appraise, assimilate, and
apply scientific evidence to patient
care without assistance
Meets expectations
Exceeds expectations
Appraises and applies evidence to Consistently appraises, assimilates
patient care with minimal assistance and applies high-quality evidence to
patient care; determines whether
clinical evidence can be applied to
an individual patient
Comments:
Overall, this student's performance, based on my interaction, in this clerkship:
Unable to Assess
Does not meet expectations
Meets expectations
Exceeds expectations
Summative Comments (for potential inclusion in Dean’s Letter):
Formative Comments:
Signature: ___________________________________________ Email Address: ___________________________________
Return this form to: OBG 430 Course Coordinator.
4610 X Street, Suite 3203
Sacramento, CA 95817. Fax: 916-734-4505