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Student Name: _________________________Date______________________________Observer Name: ________________________ Clerkship: _________________________ Circle One: AttendingFellow ResidentClerkship week #: ___________________FOCUS: Feedback and Observation of Clinical (UME) StudentsDOCUMENTATIONPlease review student’s documentation and provide them with feedback based on the behaviors listed belowAsk student about specific areas they want to work on or areas you should focus your review/feedback Encourage student assessment Describe specific behaviors- use CSEF language below as promptsGive positive and constructive feedback: at least 2 positives and 2 areas for improvement and develop an action planIMPROVE SKILLS...DocumentationA 3rd year student who is competent in this domain: ·Writes notes that are complete, accurate, and well-organized·Documents diagnostic reasoning, including a synthesis statement (i.e., “one-liner”) with a leading diagnosis and a prioritized differential diagnosis, justifying it with epidemiology (e.g., prevalence) and positive and negative findings·Creates a problem list that is appropriately prioritized and complete for major biopsychosocial problems·Provides an appropriate rationale for the management plan for common conditionsA 3rd year student who is achieving behavior beyond the 3rd year competency criteria: ·Documents pertinent positive and negative findings in a manner that enables listener to recognize/prioritize the differential diagnosis and rule in/out diseases ·Documents diagnostic reasoning clearly, including a synthesis statement with a leading diagnosis and a prioritized differential diagnosis, justifying it with relevant epidemiology (e.g., prevalence), positive and negative findings, and pathophysiology·Creates a problem list that is appropriately prioritized and complete for major and minor biopsychosocial problems·Provides an appropriate rationale for the management plan for common conditions, citing relevant guidelines and evidence where applicable·Defines discharge criteria/follow up plan for uncomplicated patients Comments -specific examples of behaviors observed or missing from above:(Note: It is okay to give your feedback verbally and have the student scribe- the important part is giving specific, timely, behaviorally based feedback)Student Reflection-What would you change or do differently? Next steps for student growth: These should be developed based on feedback from the observation and the above behaviors- student should develop these with faculty and write them here):1.2.3.? I directly observed this student? I provided verbal feedback to the studentSupervisor Signature ______________________________ ................
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