Educational Programs

Main Content

Medical Student Clinical Performance Evaluation

Student Name *

Attending Name *

Date *

Site *

Patient Care

Medical Interviewing *

Medical Interviewing Score

Physical Examination *

Physical Examination Score

Procedural Skills *

Procedural Skills Score

Patient Care Skills *

Patient Care Skills Score

Patient Care Sum

Medical Knowledge

Interest in Learning *

Interest in Learning Score

Correlates Knowledge *

Correlates Knowledge Score

Medical Knowledge *

Medical Knowledge Score

Medical Knowledge Sum

Practice-Based Learning and Improvement

Facilitates the Learning of Others *

Facilitates the Learning of Others Score

Use Scientific Studies to Manage Patient Care *

Use Scientific Studies to Manage Patient Care Score

Self-Motivated *

Self-Motivated Score

Practice-Based Learning and Improvement Sum

Interpersonal & Communication Skills

Listening & Verbal Communication Skills *

Listening & Verbal Communication Skills Score

Interpersonally Engaged *

Interpersonally Engaged Score

Presentations *

Presentations Score

Documentation & Notes *

Documentation & Notes Score

Interpersonal and Communication Skills Sum

Systems-Based Learning

Access/Utilize Other Resources *

Access/Utilize Other Resources Score

Uses Systematic Approaches *

Uses Systematic Approaches Score

Team *

Team Score

Systems-Based Learning Sum

Please note, the following professionalism section has a different grading scale than the sections above.

Professionalism

Honesty Integrity *

Honesty Integrity Score

Written Communication *

Written Communication Score

Verbal Communication *

Verbal Communication Score

Punctuality *

Punctuality Score

Appearance *

Appearance Score

Confidentiality *

Confidentiality Score

Teamwork *

Teamwork Score

Respect for Patients *

Respect for Patients Score

Responsibility *

Responsibility Score

Respect for Colleagues *

Respect for Colleagues Score

Self Confidence *

Self Confidence Score

Professionalism Sum

Please provide comments about the student's performance. Also, if anything is checked as a failing grade or there are a number of categories that are not applicable, please give comments. *