PRECEPTOR EVALUATION FORM

Medical Interview

•Conveys understanding and empathy for patient •Obtains all pertinent information •Follows an organized format •Obtains history in a reasonable time period

Physical Examination

•Explainsprocedure to patientbeforeexam •Performsexamination in an orderlysequence •Demonstrates respect for patient •Performs appropriate and accurate exam

Oral Case Presentation

•Clear, organized, concise presentation •Includes all major active complaints/problems

Patient Record

• Written materials are neat, legible,andappropriate • Accurately and adequately documents patient encounters •Electronic record, when utilized, is accurate and organized

Utilization & Interpretation of Diagnostic Tests

•Demonstrates sound knowledge of tests •Orders appropriate test(s) for working differential diagnosis •Uses appropriate discretion in ordering • Demonstrates the ability to interpret diagnostictests • Demonstrate care that is effective, safe, equitable, and high quality

Technical Skills/Clinical Procedures

•Performs procedures safely and at appropriate skill level • Understands indication(s) for procedure(s) •Explains and attains consent of patient before starting procedure

Problem Solving/Clinical Thinking

•Synthesizes and analyzes clinical data correctly • Determines major active problem accurately and in a timely fashion •Determines abnormal from normal •Utilizes and evidence-based approach to medicine

Fund of Knowledge and Application of Concepts

• Demonstrates application of basic and clinical sciences to patient care • Demonstrates evidence of outside reading and studies during rotation •Ability to apply knowledge of biomedical and psychosocial principles • Uses information technology to support the application of knowledge

Assessment/Differential Diagnoses

•Formulates and justifies differential diagnoses • Determine the etiologies, risk factors, and epidemiology for medical conditions •Identify the signs and symptoms of medicalconditions

Ability to Formulate and Implement a Follow-up and Management Plan

•Designs an effective and appropriate careplan • Selects appropriate consultations and referrals •Demonstrates an appropriate understanding of pharmacologic plan •Implements plan consistently and appropriately • Arranges for patient follow-up • Performspatienteducation at appropriatelevel •Uses counseling and patienteducation skillseffectively

Relating to Colleagues

•Ability to workcollaboratively in inter-professionalteams

Relating to Patients

•Communicates effectively and appropriately with patients •Demonstrates respect and empathy for patients

Understanding of PA Role

•Demonstrates understanding for medical conditions and situations that require an attending physician or consultation • Understands the PAprofession and the role of the PA as a team member

Reliability and Dependability

• Assumes appropriate level of responsibility •Completestasks thoroughlyand in a timelyfashion

Self-Confidence

•Demonstrates confidence in clinical competence to patient, peers, and preceptor

Attitude Toward Learning

•Demonstrates independent learning effort; undertakes supplemental readings; is inquisitive, insightful, and enthusiastic; attends conferences and lectures; and demonstrates knowledge of assignedreadings

Professionalism

•Exhibits cultural awareness • Maintains professional relationship with patients, staff, and preceptor • Demonstrates ethical behavior and attitude in accordance with AAPA’sGuidelines for

Ethical Conduct for the Physician Assistant

Profession •Respect’s patient privacy and confidentiality •Demonstrates a positive response to constructivecriticism •Dresses appropriately for professional role •Maintainsclean and kemptappearance

Student Preparedness for Clinical Clerkship

•Student waswellprepared to transition into clinicalclerkship