2017-2018 MID-CLERKSHIP FEEDBACK
Feedback Supervisor (Faculty or Resident) Instruction
1)Each student will receive a copy of the 2017-2018 Mid-Clerkship FeedbackForm at the beginning of each rotation.
2)Each student must complete the Self-Assessment section of the formand list up to 3 areas of focus prior to meeting with the supervisor.
3)During the meeting, you (the supervisor) will review the Self-Assessment section of the rating form and make an assessment of the relevance and appropriateness of the items on which the student wants to focus. You may add or subtract from the student’s list of items based on your assessment of their performance and the amount of time left in the rotation to carry out the action plans.
4)Your role is to evaluate what the student has suggested as areas of focus and provide commentsto address in the following areas:
- The accuracy and appropriateness of each of the areas of focus to the student’s level of training and learning environment.
- The feasibility of the timeline allotted to address each area of focus.
- Outline/identify activities that need to take place in order to address these areas.
- Provide concreate examples of what the student has done well.
EX. Verbal feedback: “Your goal to achieve independence is great and would be the goal for your development as a physician. We can focus our efforts on minimizing the need for input around taking a focused history from your supervisor on some of the more common conditions presented to our clinic… Let’s start with patients coming in with low back pain.”
Written feedback: “discussed specific action plan to address focus area #1 and to target history taking in the following conditions: low back pain, abdominal pain, incontinence, headache.”
5)Both the supervisor and the student will sign the form at the end of the meeting indicating that they have met and agreed on an action plan.
6)The students will turn in a copy of the completed form to the clerkship office.
The purpose of the mid-clerkship feedback is to provide students with an opportunity to identify areas in which improvementsare needed and to implement a plan for corrective actions before the end of each clerkship rotation. Information on this form is to give constructive and formative feedback to the students. It will not be incorporated into the student’s final clerkship assessment nor will it be included in the MSPE.Student Instructions:
Please rate yourself in the 14 competencies using the form provided by reflecting on how much clarification and input were required from the resident/attending with whom you worked during the first half of the rotation. Select the list of behaviors that is most representative of your performance. Once you have completed the self-assessment section, identify up to 3 areas in which you seek advice/input from your supervisor. Bring this completed form to your mid-clerkship feedback session. Your supervisor will work with you on developing a set of action plans that will help you address those areas of concerns.
Supervisor Instructions:
As their supervisor, please evaluate the student’s suggested areas of focus and provide comments regarding the following:
- Your perception of the accuracy and appropriateness of each of the areas of focus identified by the student.
- A feasible timeline needed to address each area of focus.
- Outline/identify activities that need to take place in order to address these areas.
- Concrete examples of what the student has done well.
Student Name: / Date:
Supervisor Name: / Date:
Student Areas of Focus: / Supervisor Feedback/Comments:
Student Signature: / Date:
Supervisor Signature: / Date:
Please remember to return the signed copy to the Clerkship coordinator(s).
1 / HISTORY TAKING / Student Self-assessmentHistories often inaccurate or incomplete and student requires substantial guidance. /
Histories are accurate but student requires guidance to ensure completeness. /
Histories are accurate and student completes with minimal guidance. /
Histories are accurate and appropriately focused without need for clarification. /
2 / PHYSICAL EXAMINATION
Physical exams are often inaccurate or incomplete and student requires substantial guidance. /
Physical exams are accurate but student requires guidance to ensure completeness. /
Physical exams are accurate and student completes with minimal guidance. /
Physical exams are accurate and appropriately focused without need for further clarification. /
3 / GENERATING DIFFERENTIAL DIAGNOSIS (DDX)
DDX is often irrelevant and requires substantial supervisor input. /
DDX requires guidance in order to tailor to the patient's presentation. /
DDX is appropriate with minimal supervisor input. /
DDX is appropriate and integrates current and emerging information without need for further clarification. /
4 / ORDERING AND INTERPRETING COMMON DIAGNOSTIC TESTS
Has difficulty identifying and interpreting appropriate diagnostic tests without substantial supervisor input. /
Requires guidance to identify appropriate diagnostic tests and/or interpret results. /
Able to identify and interpret common diagnostic tests with minimal guidance. /
Diagnostic tests are appropriately recommended and accurately interpreted relative to clinical context without need for further clarification. /
5 / DEVELOPING AN APPROPRIATE MANAGEMENT PLAN
Has difficulty developing an appropriate management plan without substantial supervisor input. /
Requires guidance to develop an appropriate management plan. /
Able to develop an appropriate management plan with minimal guidance. /
Management plan is well-conceived and incorporates the patient's preferences and resources. /
6 / PRESENTATION TO PRECEPTORS, PEERS and TEAM MEMBERS
Presentation is disorganized, contains inaccuracies and requires frequent redirection and clarification. /
Presentation is generally organized and accurate but requires some clarification. /
Presentation is consistently organized and accurate and requires minimal clarification. /
Presentation is organized, accurate, and appropriately tailored to the audience and situation without need for further clarification. /
7 / APPLICATION OF MEDICAL KNOWLEDGE TO PATIENT CARE
Requires substantial supervisor input to apply relevant scientific information to patient care. /
Able to apply relevant scientific information to patient care with supervisor input. /
Consistently applies relevant scientific information to patient care with minimal supervisor input. /
Incorporates current scientific information and identifies emerging evidence relevant to patient care. /
8 / PROFESSIONAL ACCOUNTABILITY & RESPONSIBILITY
Requires multiple reminders to complete assigned responsibilities. Is often late, unprepared or disorganized. Fails to take responsibility for actions, even after prompting. /
Completes responsibilities on time with minimal reminders. Is prepared most of the time. Accepts responsibility for actions with prompting. /
Completes responsibilities on time without reminders. Is prepared and organized. Recognizes and accepts responsibility for actions. /
Actively seeks out opportunities to contribute to team performance above and beyond assigned responsibilities. /
9 / MAINTENANCE OF TEACHABLE ATTITUDE
Is resistant, or responds defensively, to constructive feedback; fails to respond to repeated suggestions/feedback. /
Accepts suggestions/feedback after initial resistance, minimal evidence of attempts to incorporate changes. /
Welcomes suggestions/feedback and is willing to improve. Attempts to incorporate suggested changes. /
Embraces and actively solicits feedback; actively incorporates suggestions to demonstrate continued professional growth. /
10 / LIFE LONG LEARNING & SELF-ASSESSMENT / Student Self-assessment
Unable to recognize and acknowledge own weaknesses, even with substantial prompting. /
Able to recognize and acknowledge own weaknesses with some prompting. /
Able to recognize own limitations/weaknesses and to seek help when necessary with minimal prompting. /
Is aware of and acknowledges own weaknesses. Proactively seeks opportunities for self-improvement and professional development. /
11 / COMMUNICATION WITH PATIENTS and FAMILIES
Has difficulty communicating effectively with patients and families without substantial supervisor involvement or guidance (e.g., struggles to recognize and adapt to relevant verbal and nonverbal clues). /
Requires some supervisor involvement or guidance to communicate effectively with patients and families. /
Able to communicate effectively with patients and families with minimal supervisor involvement or guidance. /
Skillfully adapts communication content and style based on patients' and families' needs and level of understanding. /
12 / COMMUNICATION WITH TEAM MEMBERS
Has difficulty communicating effectively with team members and with recognizing their respective roles. Requires substantial guidance to balance listening with sharing. /
Requires some guidance to communicate effectively with team members, to recognize team members’ roles, and to balance listening with sharing. /
Communicates with respect for, and appreciation of, team members and their respective roles. Balances listening with sharing with minimal guidance. /
Communicates effectively with team members, clearly recognizes the scope and expectations of each team member's role, and fluidly balances listening and sharing without specific guidance. /
13 / COMPASSION, EMPATHY & RESPECT (PRIVACY and CONFIDENTIALITY)
Requires substantial supervisor involvement to behave respectfully and empathetically toward patients. Displays lapses in respecting patient privacy and confidentiality. /
Requires some guidance to behave respectfully and empathetically toward patients in stressful conditions. Demonstrates respect of patient privacy and confidentiality (e.g., knocks before entering, addresses others in the room) with minimal guidance. /
Consistently demonstrates compassion and empathy for, and respect of, patients and patients’ rights without specific guidance. /
Proactively works to meet the needs of patients. Demonstrates independent drive and initiative to advocate for patients. /
14 / DOCUMENTATION OF PATIENT ENCOUNTERS (FORMAL H&P OR PATIENT NOTES)
Documentation is not consistently reflective of the student's work or thinking and often contains inaccuracies (e.g., over reliant on cutting and pasting and/or cuts and pastes elements of the chart without appropriate corrections or updates). /
Documentation reflects the students own work and thinking, but requires supervisor involvement to identify errors (e.g., cuts and pastes elements of the chart missing some corrections or updates). /
Documentation of patient encounters is accurate. Appropriately updates information when using the cutting and pasting function with minimal supervisor involvement. /
Documentation reflects independent authorship and clinical reasoning that incorporates the current status of the patient and information from multiple sources. /