Name________________________________
Date____________________
Lagrange Family Medicine Residency Clinic
Patient Care Evaluation
1
2
3
4
5
Gathers Information
Gathers some information,
key parts missing
Gathers most information,
poor organization
Gathers most information,
organized most of the time
Gathers all information,
organized most of the time
Gathers all information, organized all
of the time
Physical Exam
Does not pick up some
physical findings
Always misses subtle
physical exam findings, poor
organization
Sometimes misses subtle
findings, organized most of
the time
Performs adequate physical
exam, organized most of the
time
Always performs appropriate exam,
organized all of the time
Interprets Data Accurately
(MK-2)
Presents data with minimal
synthesis and interpretation
Synthesizes data for a
patient with simpler problems
and interprets findings in
some cases
Synthesizes data for a
patient with complex
problems and can interpret
data in most cases
Synthesizes data for patients
with complex and multiple
problems and interprets data
in all cases
Synthesizes data for patients with
complex and multiple problems.
Adapts interpretation quickly in the
face of changes in the patient
Differential Diagnosis
Sometimes able to list most
likely diagnosis and a couple
of others
Always able to list favored
diagnosis and a couple of
others
Complete, prioritized
differential with justification
some of the time
Complete, prioritized
differential with justification
most of the time
Comprehensive, prioritized
differential with justification at all
times
Therapeutic Plans
Accuracy
(MK-2)
Relies on others to develop a
plan for further work up and
treatment
Develops some ideas for
further work up and treatment
Develops a complete plan for
further diagnostic work up
and treatment for most
patients. Beginning to
consider patient preferences
Develops a complete plan for
further diagnostic work up
and treatment for all patients.
Consistently considers
patient preferences
Develops a complete plan for further
diagnostic work up and treatment for
all patients. Plan is efficient, cost
effective and adapted to patient
preferences
Case Presentations
Presentations ill-prepared,
lack important information,
contain inaccurate data
Presentations organized,
accurate, but with some
omissions
Presentations organized,
accurate, contain all the
basic information
Presentations more concise,
articulate, with emphasis on
important issues/data; knows
all lab/radiology data
Presentations concise, articulate, and
demonstrate a high level of
insight/synthesis; minimal to no use
of notes
Note Writing
Notes unreliable,
unorganized, contain
significant omissions
Notes organized but omits
some relevant issues/data
Notes accurate, complete
and identify all ongoing
problems
Notes accurate, complete
and indicate clear plans for
each ongoing problem
Notes concise, analytical, and reflect
thorough understanding of disease
process, patient’s conditions, and
both immediate and more distant
plans
Team-Based Care
(C-3)
(SBP-4)
Understands that quality
patient care requires
teamwork and coordination;
participates as a respectful
and effective team member
Understands the roles and
responsibilities of oneself,
patients, families,
consultants, and team
members; accepts
responsibility for coordination
of care
Sustains a relationship as a
personal physician to his or
her own patients; assumes
responsibility for seamless
transitions of care
Engages the appropriate
care team to provide
accountable, team-based,
coordinated care centered on
individual needs
Role models leadership, integration,
and optimization of care teams to
provide quality, individualized patient
care
Organizes information to be
shared with patients and
families and participates in
end-of-life discussions and
delivery of bad news
Negotiates a difficult visit
agenda with a patient and
family while using active
listening skills and engaging
the patients’ perspectives
Educates and counsels
patients and families in
disease management and
health promotion skills while
maintaining patient
centeredness
Roles models effective
communication of difficult information
such as end-of-life discussions,
delivery of bad news,
acknowledgment of errors and during
episodes of crisis
Disease Management
Planning and
Communication
(C-2)
Recognizes respectful
communication with patients
and families and able to
identify physical, cultural,
psychological and social
barriers to communication
Observables Checklist
Some of
the time
Most of
the time
All of the
time
Some of
the time
Most of
the time
All of the
time
Appropriately educates family about patient’s condition
Resident appropriately recognizes or anticipates changes in patient condition (PC-1)
Resident is capable of advocating for patient and family when patient condition changes (PC-1)
Shows sophistication in disposition planning and transitions of care (SBP-1)
Demonstrates sophistication in medication management (SBP-1)
Medications reconciled and appropriate for each level of care
Integrates consultant and attending notes into plan of care (SBP-4)
Notes are concise and are completed in a timely manner
Applies evidence-based medicine and clinical practice guidelines to impact patient care (PBLI-1)
Osteopathic Manipulative Medicine – Observables Checklist
Understands the philosophy of Osteopathic Manipulative Treatment (OMT)
Understands absolute and relative contraindications to OMT
Understands the role of musculoskeletal system in disease
Demonstrates understanding of somato-visceral relationships and the role of the musculoskeletal
disease
Actively engages in the use of OMT when appropriate
Appropriately documents OMT in written note
Comments:______________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________