Enhanced Skills Maternal Newborn Care Program
Daily Field Note
Resident: ____________________________________
Preceptor: ________________________________________________
Instructions: This daily feedback and assessment tool is meant to facilitate Resident self-assessment and encourage directed
feedback by Preceptors. Residents are expected to complete the Field Note by the end of each shift, and develop a plan for
personal learning for future patient interactions. The Resident should also self-assess a minimum of 3 items below and the
Preceptor should initial in the box where they would assess the Resident for those same items if they disagree.
The Resident will also record experiences in the log book to increase awareness of procedural skill development and areas for
future clinical experiences. The preceptor will need to assess level of supervision required (levels 1-4 as outlined)
Subsequently, the Preceptor should have the opportunity to give feedback and complete the assessment form.
Preceptors – please do not feel that you need to rate each item in the competency list. Please only complete those that the
resident has self-assessed or you feel important to assess as they may have related to activities of the day. The hope is that the
list of competencies will assist in guiding directed feedback.
A. Resident reflection – what did I learn today?
Consider one or more of the items below.

B. Resident initiated learning plan for next shift
Comments:


A. Medical Expert
0
No
data
1
Rarely
meets
2
Inconsistently
meets
3
Almost
always
meets
4
Sometimes
exceeds
5
Consistently
exceeds
0
No
data
1
Rarely
meets
2
Inconsistently
meets
3
Almost
always
meets
4
Sometimes
exceeds
5
Consistently
exceeds
0
No
data
1
Rarely
meets
2
Inconsistently
meets
3
Almost
always
meets
4
Sometimes
exceeds
5
Consistently
exceeds
1. Demonstrates adequate knowledge of relevant clinical
practice guidelines to provide safe and competent care
2. Consistently demonstrates broad differential and critical
thinking skills to narrow the differential diagnosis and
establish management plan
3. Demonstrates increasing competence and confidence in
procedural skills list in learning objectives
B. Communicator
1.
Demonstrate use of appropriate level and tone of
communication with patients
2. Demonstrates mindful approach to practice by
demonstrating composure even in stressful situations
C. Health Advocate
1.
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Demonstrates ability to consider social determinants of
health in maternal newborn outcomes
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2.
Demonstrates consideration of patient safety lapses and
their management
D. Collaborator
0
No
data
1
Rarely
meets
2
Inconsistently
meets
3
Almost
always
meets
4
Sometimes
exceeds
5
Consistently
exceeds
0
No
data
1
Rarely
meets
2
Inconsistently
meets
3
Almost
always
meets
4
Sometimes
exceeds
5
Consistently
exceeds
0
No
data
1
Rarely
meets
2
Inconsistently
meets
3
Almost
always
meets
4
Sometimes
exceeds
5
Consistently
exceeds
0
No
data
1
Rarely
meets
2
Inconsistently
meets
3
Almost
always
meets
4
Sometimes
exceeds
5
Consistently
exceeds
1.
2.
Demonstrates respect for colleagues and team members
Demonstrate effective communication with all team
members to ensure best patient outcomes
Leader
1.
Demonstrates ability to distinguish urgent from
emergent from routine and prioritise management
appropriately
E. Scholar
1.
Demonstrates use of evidence basis in clinical practice
2.
Demonstrates ongoing inquiry and responsibility for
continuing medical education
F. Professional
1.
Demonstrates awareness of own limits of clinical
competence and seeks help when warranted
2. Demonstrates respect for patients in a caring and
compassionate manner
3. Demonstrates flexible approach to deal with uncertainty
G. Overall Resident Feedback
Comments:
H. Preceptor Feedback
Comments:
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