Coaching–Clinic Observation

**Coaching forms represent formative feedback only and are not intended to be used for learner assessment

LEARNER: ______Date: ______

OBSERVER:______Location: ______

History-taking / Not done / Something to focus on / Done adequately / Not applicable
Learner…
  • Introduces self and explains role

  • Stays with open-ended questions for an appropriate amount of time

  • Deliberately explores the patient’s perspective, including explanations for symptoms, fears/worries, expectations for treatment1

  • Inquires thoroughly about the presenting problem/chief complaint2

  • Performs efficient history that targets reason for patient’s visit and initial differential diagnosis2

  • Avoids interrupting

  • Appears comfortable and unhurried

  • Conveys support, concern, respect (verbally and non-verbally)3&4

  • Includes child in the interview in a developmentally appropriate way

  • Uses straight-forward language (e.g. avoids using medical jargon)1

  • Recognizes the need for an interpreter; uses interpreter effectively1

  • If learner provides information to the patient/family, content is accurate and appropriate5

Physical Exam / Not done / Something to focus on / Done adequately / Not applicable
Learner…
  • Washes hands

  • Minimizes discomfort

  • Preserves modesty

  • Builds rapport

  • Explains to parent what he/she is doing1

  • Explains to child what he/she is doing1

  • Performs efficient exam that targets reason for patient’s visit and initial differential diagnosis2

  • Adapts sequence of exam to child’s cooperation level

  • Includes exam elements appropriate for patient’s age

  • Modifies approach to exam in response to changes in patient’s level of cooperation or comfort

  • Demonstrates correct exam technique

  • Elicits accurate findings

Presenting a patient to clinic preceptor / Not done / Something to focus on / Done adequately / Not applicable
Learner…
  • Presents appropriate amount of detail in history1

  • Presents appropriate amount of detail in physical exam1

  • Creates an accurate, concise, prioritized assessment5

  • Provides an appropriately prioritized differential5

  • Creates a prioritized problem list5

  • Creates a reasonable plan5

  • Well-organized presentation

  • Incorporates evidence-based medicine into plan

  • Proposes appropriate follow-up plan and action items

  • Identifies learning needs with each patient (e.g., asks a question of preceptor or states plan to follow-up in learning about patient).

Self-Reflection / Feedback on
Self-Reflection / Feedback Highlights / Other notes
Keep:
Suggestions:

Adapted from SCO, Lindsey Lane, Jefferson Medical School and Dan West, et al. Western Pediatric SCO

1- Pediatric Milestone PC1: “Gather essential and accurate information about the patient.”

2- Pediatric Milestone ICS1: “Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds.”

3 - Pediatric Milestone ICS2: “Demonstrate the insight and understanding into emotion and human response to emotion that allows one to appropriately develop and manage human interactions.”

4 - Pediatric Milestone P1: “Humanism, compassion, integrity, and respect for others; based on the characteristics of an empathetic practitioner.”

5 - Pediatric Milestone PC4: “Make informed diagnostic and therapeutic decisions that result in optimal clinical judgment.”