Elective Interesting Case Presentation Evaluation Form Student Rotation Type
Faculty Site
Date
Rotation Dates
Preceptor Name
\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ SCORING: 0 = Not done, 1/5 = Poor, 5/5 = Excellent TOPIC: HISTORY: Descriptors included in HPI Clear & concise HPI HPI includes pertinent positive and negatives Includes all pertinent past medical history
COMMENTS 0 0 0 0
1 1 1 1
2 2 2 2
3 3 3 3
4 4 4 4
5 5 5 5
PHYSICAL EXAM: Focused physical exam-including all components 0 Includes pertinent positive & negative PE findings 0
1 1
2 3 4 2 3 4
5 5
LABS/DIAGNOSTIC PROCEDURES: Utilization of appropriate diagnostic tests Presents pertinent findings
0 0
1 1
2 3 4 2 3 4
5 5
DIAGNOSIS: Addresses both acute, chronic disease & HCM Ability to formulate & eliminate differential dx Describes pathophysiology of disease state
0 0 0
1 1 1
2 3 4 2 3 4 2 3 4
5 5 5
MANAGEMENT: Understands pharmacologic therapy Discusses appropriate non-pharmacologic therapy Addresses disease prevention/HCM Provides patient with follow-up instructions
0 0 0 0
2 1 2 1
4 2 4 2
8 4 8 4
10 5 10 5
PATIENT EDUCATION: Development of patient education materials
0
2
4 6 8
10
PROFESSIONALISM:
0
1
2 3 4
5
6 3 6 3
_
TOTAL POINTS Faculty Signature:
Date:
103
__
