Formative Assessment Form - Learning Communities

University of Cincinnati College of Medicine Learning Community Student Evaluation by Faculty Student Name: __________________________________________ LC #: _____ Curriculum Year, Date: __________________________________ Area of Evaluation Integration and Approach to Patient Care Learning Objectives: 1,2,3

Interpersonal and Communication Skills

Basic Competence Initial differential diagnoses are limited and/or inaccurate. Poor ability to draw conclusions from the clinical information.

Limited ability to choose the appropriate testing for the patient.

Initial differential diagnoses are accurate, but lack depth. Able to choose some initial basic testing appropriate for the patient. Shows satisfactory clinical reasoning.

Initial differential diagnoses are good, but occasionally lack depth.

Able to identify most basic testing appropriate for the patient. Shows good clinical reasoning.

Does an excellent job developing broad initial differential diagnoses.

Able to narrow them with the use of appropriate testing.

Shows excellent clinical reasoning.

Does an outstanding job developing broad initial differential diagnoses.

Well able to narrow them with the use of well chosen testing. Shows advanced clinical reasoning.

At times communicates in a disrespectful manner. At times causes disruption to the group dynamic. Does not always work well with other group members.

Displays appropriate communication skills.

When involved in a discussion, able to interact appropriately, but does not take action to improve the group dynamic. Able to collaborate with group members.

Communicates in a respectful manner.

Interacts appropriately during group discussions. Works well with other group members.

Always communicates effectively in a respectful manner. Occasionally shows ability to resolve group conflict during group discussions or projects. Works very well with other group members.

Always communicates effectively in a very respectful manner.

Shows strong ability to resolve group conflict during group discussions or projects. Works exceptionally well with other group members.

Rarely contributes to group discussions and activities. Does not initiate discussions or contribute new ideas to the group. Does not show leadership skills.

Able to participate in group discussions and activities. Will respond to conversation points, but does not usually initiate discussions.

Shows satisfactory leadership skills during group projects.

Active in group discussions and activities. Occasionally initiates discussions.

Contributions may not be frequent, but makes good insightful comments.

Shows good leadership skills during group projects.

Very active in group discussions. Sometimes initiates discussions and/or takes discussion in a new direction.

Shows excellent leadership skills during group projects.

Always very active in group discussions and activities. Often initiates discussions and makes strong positive contributions. Shows outstanding leadership skills during group projects.

Learning Objectives: 7

Participation and Leadership

Learning Objectives: 9

July 2017

Individuals have permission to use as long as proper attribution to University of Cincinnati College of Medicine is provided

University of Cincinnati College of Medicine Learning Community Student Evaluation by Faculty Student Name: __________________________________________ LC #: _____ Curriculum Year, Date: __________________________________ Practice-Based Learning and Improvement Learning Objectives: 4,5

Lack of insight into gaps in one’s own knowledge base. Has difficulty finding appropriate educational resources and/or cannot discriminate between good evidence-based resources and unreliable resources.

Learning Objectives: 1,2,3

Professionalism

Learning Objectives: 6,8

Good ability to identify strengths, deficiencies and limits in their own knowledge. Consistently uses common educational resources, and occasionally locates additional quality evidence-based resources.

Excellent ability to identify strengths, deficiencies and limits in their own knowledge.

Often locates and critically evaluates quality evidence-based resources to seek effective treatment and health promotion.

Outstanding ability to identify strengths, deficiencies and limits in their own knowledge.

Consistently locates and critically evaluates quality evidence-based resources to seek effective treatment and health promotion.

Basic Competence

Area of Evaluation Preparation

Satisfactory ability to identify major gaps in their own knowledge.

Able to locate common educational resources to guide effective treatment and health promotion.

Has a basic ability to critically evaluate educational resources.

Does not put forth consistent effort to review cases and answer case questions. Does not complete assignments in the appropriate time frame. Does not contribute fair share of workload on group projects.

Displays satisfactory effort toward case analysis. Provides basic answers to case questions, but little evidence of extra effort.

Usually completes all assignments on time.

Average contributor to group projects.

Displays good effort toward case analysis and answering of case questions. Completes all assignments in a timely manner. Good contributor to group projects.

Displays excellent effort toward case analysis and answering of case questions. Completes all assignments in a timely manner. Very good contributor to group projects.

Puts outstanding effort into case analysis, thoughtfully answering all case questions.

Completes all assignments in a timely manner. Very strong contributor to group projects.

Lack of sensitivity to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities and sexual orientation. Lack of respect for patient privacy and autonomy.

Poor ability to evaluate ethical issues.

Satisfactory sensitivity to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities and sexual orientation.

Shows basic respect for patient privacy and autonomy. Satisfactory ability to evaluate ethical issues.

Good sensitivity to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities and sexual orientation.

Shows good respect for patient privacy and autonomy. Good ability to evaluate ethical issues.

Excellent sensitivity to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities and sexual orientation. Very good respect for patient privacy and autonomy.

Excellent ability to evaluate ethical issues.

Outstanding sensitivity to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities and sexual orientation. Great respect for patient privacy and autonomy.

Outstanding ability to evaluate ethical issues.

Student’s strengths: _________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ July 2017

Individuals have permission to use as long as proper attribution to University of Cincinnati College of Medicine is provided

University of Cincinnati College of Medicine Learning Community Student Evaluation by Faculty Student Name: __________________________________________ LC #: _____ Curriculum Year, Date: __________________________________ Areas to improve: ___________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________

Student performance on Self-Directed Learning questions (please comment on the quality and variety of questions chosen, the quality of the answer to the question, and your perception of the quality and validity of the sources used): ______________________________________________________ _________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ Progress from previous evaluation/other comments: ___________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________

Learning Community Facilitator Signature: ________________________________________________________ Date Completed: _________________________________ July 2017

Individuals have permission to use as long as proper attribution to University of Cincinnati College of Medicine is provided