2021-2022 Clinical Handbook Agreement Form

Interesting Case Presentation Evaluation Form

Student

Rotation Type Site Faculty

Date _________________

Rotation Dates Preceptor Name ______

SCORING: 0 = Not done, 1/5 = Poor, 5/5 = Excellent

TOPIC: COMMENTS

HISTORY:

Descriptors included in HPI

0 1 2 3 4 5 Clear & concise HPI 0 1 2 3 4 5 HPI includes pertinent positive and negatives 0 1 2 3 4 5 Includes all pertinent past medical history 0 1 2 3 4 5

PHYSICAL EXAM:

Focused physical exam-including all components 0 1 2 3 4 5 Includes pertinent positive & negative PE findings 0 1 2 3 4 5

LABS/DIAGNOSTIC PROCEDURES:

Utilization of appropriate diagnostic tests 0 1 2 3 4 5 Presents pertinent findings 0 1 2 3 4 5

DIAGNOSIS:

Addresses both acute, chronic disease & HCM 0 1 2 3 4 5 Ability to formulate & eliminate differential dx 0 1 2 3 4 5 Describes pathophysiology of disease state 0 1 2 3 4 5

MANAGEMENT:

Understands pharmacologic therapy 0 2 4 6 8 10 Discusses appropriate non-pharmacologic therapy 0 1 2 3 4 5 Addresses disease prevention/HCM 0 2 4 6 8 10 Provides patient with follow-up instructions 0 1 2 3 4 5

JOURNAL:

Discusses or writes a summary of article Submits supporting journal article (< 5yrs old) 0 2 4 6 8 10

PROFESSIONALISM:

0 1 2 3 4 5

TOTAL POINTS

Faculty Signature: Date: __