Appendix: Evaluation forms
Resident Evaluation Sheet
Sample #: ____
Date: _________
Which style did you use for this case presentation? ______ Chief Complaint Oriented
______ Assessment Oriented
1. Please evaluate your oral presentation of case data to the degree of detail a reasonable preceptor
should require:
Insufficient
Appropriate
Excessive
content:
content:
content:
 Lacking in
 Sufficient detail
 Burdensome
necessary detail


 All necessary
Required extensive
data was
supplementation
provided
Required repeat
patient
detail
 Unnecessary
data was
 No need for
provided which
supplementation
I should have
excluded
interview/exam
2. Please evaluate your expression of case medical
decision making:
Superficial
Appropriate:
Protracted:

 Assessment and
 Details of
Failed to express
my thought
management
assessment
processes or
proposal
and
conclusions
outlined in
management
degree of detail
proposal more
ideal for cases
elaborate than
of this nature
warranted by
nature of case
Assessment Oriented Oral Case Presentation
3. Please mark on the scale regarding your case presentation organization:
 Presentation was
I

fragmented and
meandering
 Was difficult to
verbally organize my
organized and easy to
P
O 1
D
2
3
4
5
6
7
8
9
E
express

Integrated the facts of
this case succinctly
O
A
R
L
thoughts
 Frequently needed to
Presentation was well

No need for
redirection or
restatement
redirect or restate the
presentation
4. Please mark on the scale regarding your overall
satisfaction with this oral case presentation
and resident interaction:
Frustrating
Gratifying
I
interaction:
 Unable to demonstrate
and express my
P
O 1
D
2
3
4
5
6
7
8
9
E
clinical abilities
 Unnecessary energies
spent clarifying details
interaction:
 Able to demonstrate
and express my
clinical abilities
O
A
R
L
 We were able to
maximize
or impressions,
educational
energies Which I
opportunities and
would have preferred
discuss case fully
to have spent receiving
teaching or feedback
1
Assessment Oriented Oral Case Presentation
Faculty Evaluation Sheet
Sample #: ____
Date: _________
Which style was used for this case presentation? ______ Chief Complaint Oriented
______ Assessment Oriented
Case Complexity:
___1. Simple
___2. Moderate
___3. Complex
1. Please evaluate the resident’s oral presentation of case data:
Insufficient
Appropriate content:
Excessive
content:
 Sufficient detail
content:
 Lacking in
necessary detail

Evident failure to
gather data

 All necessary data
was provided
 No need for
supplementation
 Burdensome
detail
 Unnecessary
data was
Required
provided
extensive
 Provided
supplementation
much data I
disregarded
2. Please evaluate, given the resident’s experience and level of training, their expression of case
medical decision making:
Superficial
Appropriate:
Protracted:

 Assessment and
 Details of
Lacking in
conclusive
management
assessment
assessment or
proposal outlined in
and
management
degree of detail ideal
management
proposal
for cases of this
proposal more
nature
elaborate than
warranted by
nature of case
2
Assessment Oriented Oral Case Presentation
3. Please evaluate the resident’s case presentation organization:
 Presentation was
I

well organized and
fragmented and
meandering
 Difficult to process data
P
O 1
D
2
3
4
5
6
7
8
9
E
easy to follow

was organized and
O
A
R
L
content aided data
processing

sequenced
No need for
redirection
 Necessitated frequent
redirection
Organization and
integration of
due to poor manner in
which the information
Presentation was
.
4. Please evaluate your overall satisfaction with this precepting interaction:
Gratifying
I
Frustrating
interaction:
 Presentation failed to
meet expectations or
clinical needs, was
confusing or
unconvincing
 Presentation was boring
 Unnecessary energies
spent clarifying details or
impressions
P
O 1
D
2
3
4
5
6
7
8
9
interaction:
 Presentation met
expectations and
E
clinical needs,
O
A
R
L 
was persuasive
Presentation
advertised
resident’s clinical
competence
 We were able to
maximize
educational
opportunities and
discuss case fully
3
Assessment Oriented Oral Case Presentation
Observer Evaluation Sheet
Sample #: ____
Date: ___/___/___
Time of Day: __________
Resident physician:__________________
Attending physician:___________________
Time of Presentation: _____ seconds
Which style was used for this case presentation? ______ Chief Complaint Oriented
______ Assessment Oriented
Number of presentation interruptions by faculty: ______
Number of interruption points the resident could
not (_____)/ could(_______)
provide
response to
Did the resident need to return to the bedside to gather more information?
NO / YES
4
Assessment Oriented Oral Case Presentation
Please mark on the scale regarding the level of interpersonal tension evident in this resident-faculty
interaction:



Resident and attending
able to express their
unable to complete the
thoughts
thoughts they wished to
Collegial and
L
Easily reached
consensus on

O 1
W
2
3
4
5
6
7
8
9
I

Minimum of discussion
beyond requests for
clarification
G

assessment or
management
express
H
respectful discussion

Resident or attending
H
Reaching consensus on
assessment or
management was
Evident contentment
difficult or not achieved

Evident anger,
frustration, or hostility
5