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University of Miami
Miller School of Medicine

Comprehensive Competency Assessment Week

Class of 2017

Second-Year MD Student Manual

April 27 - May 1, 2015

Ross J. Scalese, M.D. Paul Méndez, M.D.

Gordon Center for Research in Medical Education Director, Clinical Skills Program
305-243-6491 305-243-6499

 
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Comprehensive Competency Assessment Week
Second-Year MD Student Manual

Purpose

The purpose of the Comprehensive Competency Assessment Week (CCAW) is to


assess student learning in an integrated way. The exercises are meant to test
knowledge and performance of skills not merely to assign a grade, but to assess
student competency in the integration and utilization of knowledge and skills in the
basic and clinical sciences.

The focus of all the exercises is on the process involved in how you use
knowledge, skills, and attitudes acquired during the second year. Ultimately, it will be
a reflection on how well you have learned to self-direct your learning. It is a
requirement that all students participate successfully in all components of the CCAW
at the end of the first two years. Advancement to the next year in the curriculum is
dependent on having done so. Passing all components of both years will be
necessary in order to begin third-year clerkships. Therefore, for the very few students
who have a truly emergent situation that interferes with completion of all tasks,
make-up sessions must be completed by the Friday before the beginning of the
next year; these must be coordinated through the Deans' Offices.

The complexity of the schedule throughout the week necessitates that you arrive
ahead of time, whenever and wherever you are scheduled. Regrettably, there will be
no opportunity to alter an individual's schedule or reschedule a missed session
once the week has begun. Therefore, it is imperative that you become familiar with
your individual schedule and all of the information in this manual.

The exercises throughout the week are valuable learning opportunities. Adhering to
the utmost professional behavior is critical to making this a productive experience for
everyone involved.

Overview
Orientation to CCAW activities overall will take place April 14, 2015.
Orientation to the Careers in Medicine website, PULSE surveys, and devising the
Personal-Professional Development Plan will take place April 21, 2015.

Monday, April 27 or Tuesday, April 28


SP-based exercises: History-taking (AM) and Physical Exam (PM)

Monday, April 27 or Tuesday, April 28


NBME blueprint exam: AM on the alternate day from SP-based exercises

Wednesday, April 29 or Thursday, April 30


Video review/feedback sessions

Wednesday, April 29 or Thursday, April 30 or Friday, May 1


Faculty advisors meet one-on-one with students
Submit Personal-Professional Development Plan, CV, Careers in Medicine printout

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Deadline

Friday, May 1 before 5:00 PM


• E-mail copy of CV to OPDCG (Sharon Goni)
• Complete online CCAW evaluation*

*Please complete your evaluation of the entire week after your individual faculty
advising session. For the majority of the class, this will be on May 1, so please
complete the evaluation immediately afterward, while events of the week are fresh
in your mind. For those who meet their advisor another time and for others who
haven't yet completed the evaluation, the form will remain open online until 5:00 PM
on May 8, 2015.

Rules and Regulations

Because the whole week has been designated an "exam week", there are certain
expectations regarding student behavior:

1. The content of the various individual exercises is deemed to be confidential.


The sharing of data from any of these components or aiding a classmate in the
completion of these exercises will be considered a breach of the Honor Code.

2. Wear your ID badge at all times.

3. Dress requirements

For all exercises involving “patients” (including standardized patients and other
simulations) – namely, the History-taking and Physical Examination exercises and
Patient Safety activities – it is expected that you will adhere to the Clinical Dress
Code:
• Dress should be professional. You should appear appropriately attired,
clean, and well-groomed, as when you see patients in the hospital,
clinic, or office setting.
• Acceptable clothing includes:
For women: dresses or blouses and skirts or slacks.
For men: shirts, slacks, ties encouraged.
(No one is to wear jeans, shorts, sneakers, or sandals.)
• If your dress is not considered appropriate, you will be given feedback,
to include a possible filing with the Professionalism Incident Reporting
System (PIRS).

For other activities (e.g., computer exams, video review and faculty advisor
sessions, etc.), you may follow usual UMMSM dress code standards.

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Components

Components requiring scheduling of the individual student:

I. SP Physical Examination Exercise - 30 minutes

The student will be given various clinical scenarios and asked to perform
relevant components of the physical examination. The physical examination
exercise will be video-recorded for future review.

II. SP History-taking Exercise - 30 minutes

The student will elicit a history from the SP and then document the
encounter with a patient note. The SP encounter will also be video-recorded
for later review and feedback in small groups.

III. NBME Blueprint Exam – 3 hours

IV. Small Group Video Feedback Exercise

One facilitator and 6-8 students will review and provide feedback on SP
encounters, from which each student will select a 5-minute segment of the
video-recording for self-reflection and group discussion. Facilitators will assess
each student.

V. Faculty Advisor Session – 30-45 minutes

Components to be completed by the student during the first three or four days
of the week:

Devising individual Personal-Professional Development Plan and updating


of Curriculum Vitae

These are to be brought to the Faculty Advisor Session for review


and inclusion in the Learning Portfolio.

If any revisions need to be made, the revised documents must be


submitted to the Doctoring Office by 5:00 PM on Friday, May 1.

PULSE Surveys
N.B.: Students will NOT complete PULSE (Physician Universal
Leadership Skills Education) self and peer surveys during the CCAW
this year. Rather, these will be completed after students take USMLE
Step 1 and return to campus for the Interprofessional Patient Safety
Week prior to beginning third-year clerkships.

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Directions for Exercises

SP Physical Examination Exercise

The SP Physical Examination Exercises will take place in the afternoon on M o n d a y ,


A p r i l 2 7 o r Tuesday, April 28 from 1:00 to 5:00 PM.

The objective is to determine whether students have achieved basic competency in


physical exam techniques, with a focus on level 2 physical exam benchmarks. In
addition, this exercise will provide students with direct observation and feedback on their
examination technique.

Through a series of simulated clinical cases, you will be asked to perform the most
appropriate components of the physical exam on a standardized patient over a 28-
minute period. A faculty member will be present to observe your technique and complete
a form indicating whether or not you performed each aspect of the exam correctly. The
faculty member will provide feedback to you at the end of each clinical case.

In preparation for this exercise, you should utilize information derived from the
Doctoring course clinical skills lectures, small group discussions, and Academic
Society training sessions.

Competency will be determined according to a minimum acceptable standard. Those


students who do not achieve a ''passing" score will be required to take part in a
remediation program until they can demonstrate competency.

• Please bring all of your equipment (BP cuff not required).


• Dress requirements: See p. 3 for Clinical Dress Code.
• You may not bring purses, book bags, or backpacks into the examination room.

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SP History-taking Exercise

The SP History-taking Exercise has four related components:


• SP encounter
• Patient note
• Self-assessment of the video recording
• Small group review and feedback on the video recording

These exercises will take place in the morning on Monday, April 27 or Tuesday, April
28 from 8:00AM to 12:00 PM and will last up to 30 minutes (although students
typically take about 20 minutes). During this time the student will follow the guidelines
for patient contact and elicit a history of the patient's problems.

A 5-minute warning will be given to permit bringing the encounter to closure.

The encounter will be video-recorded.

Assessment of the encounter by the SP will be based on the process of the interview
with associated student behavior and communication/interpersonal skills.

The patient note will take place immediately after the SP encounter and will consist of
documenting the patient's history. The patient note must be turned in before leaving the
test site. This note will be evaluated by faculty who will provide written feedback.
Examples of the forms you will use for this part of the exercise and the scoring rubric
that will be followed to evaluate these write-ups are shown in Appendix Ill. Sample
patient notes and a listing of abbreviations you may utilize in these write-ups are
provided in Appendix IV.

The self-assessment of the video recording must be completed prior to the small
group meeting on Wednesday, April 29 or Thursday, April 30. As part of the self-
assessment, students should Identify a discussion-worthy 5-minute segment of the
interview and cue the recording to start there.

The small group consisting of one facilitator and 6-8 students will meet to review
each student's self-identified video segment and offer feedback.

The student self-assessment form is to be completed and brought to the small group
meeting. This form will then be turned in by the faculty facilitator to be added to each
student’s Learning Portfolio after completion of the small group session.

The faculty facilitator will assess students’ ability to provide and receive constructive
feedback during these small group sessions.

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NBME Blueprint Exam

This computer-based test will consist of actual National Board exam items chosen
according to the Miller School of Medicine curricular blueprint for the organ-based
modules you have completed during the past two years. Student performance on this
exam allows us to evaluate effectiveness of our pre-clinical curriculum as it compares
across the two different degree tracks (MD and MD/MPH) and against national
standards. Students will be scheduled for a 3-hour block, which includes 2.5 hours
for the 100-item exam per se, plus time for administrative functions and an optional
tutorial.

Faculty Advisor Session

Expectations for the one-on-one session are that the student and advisor will review
• results of the CCAW exercises
• other contents of the Learning Portfolio
• student's grades
• notices of deficiencies
• student's Individual Learning Plans and CV from last year and the first iteration of
the Personal-Professional Development Plan, which will be brought to the
Faculty Advisor Session along with an updated CV. (See Appendices I and II for
more information.) These documents will then be re-visited during advisory
Deans' meetings in the third and fourth years.

The Faculty Advisor will also make an assessment of the student's interaction during
the session.

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APPENDICES

I. Personal-Professional Development Plan (PPDP)


Introduction
Description of Careers in Medicine Inventories
Components of the PPDP
Review of the PPDP
Sample PPDP

II. Curriculum Vitae (CV)


Introduction
Available resources

Ill. Assessment Instruments


Standardized Patient's Evaluation of Student
Standardized Patient Encounter: Documentation of Patient History
Standardized Patient Encounter: Patient Note Scoring Rubric
Standardized Patient Video Review: Self-assessment
Standardized Patient Video Review: Facilitator Assessment
Faculty Advisor Report on Student Conference

IV. Supplemental Materials for Standardized Patient History


Samples for Documentation of Patient History
Common Abbreviations for the Patient Note

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I. Personal-Professional Development Plan (PPDP)

Introduction and log-on instructions

The purpose of the Personal-Professional Development Plan (PPDP) is to help you


develop habits of self-reflection that will help guide you with your long-term personal and
career decisions. At the core of professional development is the ability to take the
initiative in diagnosing your needs, formulating your goals, identifying resources, and
evaluating outcomes.

In order to create your PPDP, you will be utilizing the Careers in Medicine program:
http://www.aamc.org/cim. Many of you have already accessed the site.

IF YOU HAVE NEVER accessed Careers in Medicine, please take a moment to at least
ensure your ability to log on PRIOR to the start of Competency Week. This will allow you
more time to devote to the activity, if you need some assistance retrieving old
information. For those who have not logged on, please follow the detailed instructions
below:

Instructions for using Careers in Medicine website:

1. Logging On - refer to the Careers in Medicine "quick reference guide"


provided at the end of this section
2. If you have previously created an account on this website, use your
established username and password. If you are new to the site, log on to the
main page at the above website. You will be asked to login using the SAME
username and password you used for all of your AMCAS activities when you
applied to medical school.
3. If you do NOT remember either your AMCAS username OR password, click
on either blue tab: Forgot Username or Forgot Password. You will be
prompted to enter your information for the site to retrieve the old info. The
more information you provide the better. NOTE: if you enter an EMAIL
address for the purpose of retrieving your username and/or password, make
sure you enter the Email address you USED at the time you last used
AMCAS. Once you establish your username and password you WILL have
the opportunity to update your email address.
4. If you still have trouble logging on please email the Careers in Medicine team
at careersinmedicine@aamc.org for assistance.

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ONCE YOU ARE LOGGED ON:

1. Click on CHOOSE YOUR SPECIALTY


2. Click on “FIND YOUR FIT”
3. In the right hand column, you will see a list of exercises to choose from under
“TOOLS.”
You will complete ONE of the following TWO Inventory Options (but you are
welcome to complete both):
a. Medical Specialty Preference Inventory (MSPI) or
b. Specialty Indecision Scale (SIS)
4. Select ONE Assessment tool and complete the exercise.
5. Once you complete the exercise, go back to the main menu/home page and
select your “Assessment tracker” in the right hand column.
6. Click on the results of your assessment and you will have an option to print this
out and document which exercise you completed.

NOTE: If this will be your first time logging on to Careers in Medicine, PLEASE
log on the week PRIOR to competency week, even if you complete the exercise
later. This will allow you time to ensure that you can troubleshoot any difficulty
you may encounter getting onto the site!

How do I decide which assessment is best for me? While we hope that you will revisit
the Careers in Medicine site several times between now and when you graduate, at this
point in time you are all in different stages of self-awareness and indecision. Review the
attached descriptions of the two inventories and decide which you think will be most
useful to you.

By the end of the Comprehensive Competency Assessment Week, you will have created
your individual PPDP that your Faculty Advisor will review with you. This PPDP will serve
to initiate career discussions with your future advisors and Deans.

Components of the Personal-Professional Development Plan

I. List
*what needs to be developed
*why it needs to be developed

List at least three and up to ten goals (Personal and Professional). They should be
specific, focused, measurable and relevant to your development as a physician.

The objectives should be written using action verbs [describe, evaluate,


translate, interpret, identify, analyze, predict]

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II. Resources/Strategies
*how is your goal going to be developed?
*what will be done to learn and develop?
*what resources will be used?

The methods for each goal should be practical and directly related to achieving
the goal.

III. Target date


* in what time frame the development plan will be accomplished?

The goals should be prioritized. Dates should be realistic.

IV. Verification
*how will a record be kept of progress and outcomes?

Verification must be measurable.

V. Development process
*how formulation of this plan will link to past and future development

Review of the PPDP

i. Personal Review of your PPDP should answer the following questions:


What do I now recognize about myself that I did not realize before?
Has my self-reflection helped me understand my personal and
professional goals, short-term and long-term?
Has the plan made a difference in how I will do something in the future?

Use this checklist to specifically assess your development goals (personal and
professional):
Are they:
* clearly stated?
* realistic and achievable?
* appropriate for your experience and stage of development?
*worthwhile?
* recognized as starting points and modifiable?

ii. Faculty Advisor Review of the PPDP should answer the following questions:
Has the student created a profile on Careers in Medicine site?
Has the student completed one of the CiM inventories?
Have the personal and professional objectives been stated?
Is there evidence of reflection and original thought?
Is there evidence of realistic goal-setting?

See the attached sample of how you might devise a PPDP and how, using the questions
posed above, you can review this yourself and with your faculty advisor to set concrete,
achievable goals and begin your process of self-reflection about career and personal
choices for the future.

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SAMPLE PERSONAL-PROFESSIONAL DEVELOPMENT PLAN

Development Goal Method of Achieving Goal Date of Review ® & Means of Comments and
Personal/Professional Date of Completion Verification Concerns

Create a Careers in Log onto www.aamc.org/cim Logon week of Have web access to
Medicine Profile Follow loq on instructions 4/27/15 site

Complete CiM Complete one of the two self- During week of Print out personal
Inventory assessment inventories on the 4/27/15 profile page
CiM website Complete by 5/1/15
Improve my Spanish Utilize Spanish vocabulary book Ongoing Personal review May not learn
proficiency Utilize Rosetta Stone if quickly enough
available
Join an Interest Log onto Student Government Fall semester 2015 Personal Review
Group in my specialty website and inquire about which
interest of choice specialty qroups are active
Focus on improving Reflect on what holds me back Continuous Personal Review
my ability to from answering questions in a Clerkship evals
participate assertively group setting. Be willing to Discuss w/advisor
on a team improve my confidence
Plan to engage in Seek out faculty in my area of Meet with faculty by Personal Review Not sure of my
clinical research interest (by meeting with faculty 9/2015 Review by Advising specialty interest
project in OPDCG & with Mrs. Dean
Biederman, or advisors)
Maintain my personal Continue daily exercise (or Continuous I worry that I won't
health several times a week) while I have time for "me"
beqin mv clinical rotations while on the wards
Attain leadership Get more involved in groups Summer 2015 Personal Review Hoping to be able
opportunities with leadership options to "teach"
underclassmen

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II. Curriculum Vitae (CV)

The Curriculum Vitae (CV) provides a concise summary of your personal and
professional development. It documents formal education, employment, research and
publications, involvement in activities, etc. This will be an important tool in your
professional life going forward, often required as part of applications for employment,
research opportunities, residency positions and the like. Although you may feel that your
CV is "skimpy" at this early stage in your career, you should realize that it is an evolving
document to which you will add as your personal and professional experiences broaden
and deepen. We thought it a useful exercise to begin developing your CV at the end of
first year, and now we require that you update your CV as part of the CCAW exercises
this year.

We hope that updating your CV will be a reflective exercise as well, because it requires
that you look back at your personal history, training, and accomplishments to date; in the
process, you may discover that goals set earlier (e.g., in the ILP from last year?) may
remain as yet unrealized. Such revelations, in turn, may form the basis for new goals
that you enumerate in your Personal-Professional Development Plan. For this reason,
these two activities are purposely linked: you will work on both documents during the
week and bring these to your individual advising session to be reviewed and discussed
with your faculty advisor and included in your learning portfolio.

***We request that you also e-mail an electronic version of your CV to Ms. Sharon Goni in
the Office of Professional Development and Career Guidance: sgoni@med.miami.edu.***

Available resources to help with this exercise:

As part of the CV writing assignment, you should visit the webpage for the Office of
Professional Development and Career Guidance:
http://www.mededu.miami.edu/MedEd/opdcg/index.htm

Examples of CVs are shown under "Document Samples" at the upper right of the page.

Consider watching the workshop on "Writing a CV and Personal Statement" by Dr. Hilit
Mechaber and Mrs. Joyce Biederman (link is at lower left under "Professional
Development").

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Ill. Assessment Instruments

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Student Name: SP Evaluator: _________

Standardized Patient’s Evaluation of Student

Please assess the following behaviors using this scale:

0 – NOT DONE
1 – NEEDS IMPROVEMENT – a performance I would prefer to see improve
before student becomes a doctor
2 – ACCEPTABLE – I feel comfortable with this student’s performance
(most students will perform at this level.
3 – OUTSTANDING – definitely performed better than most other students

Is appropriately attired 0 1 2 3

Greets warmly and addresses me by appropriate name 0 1 2 3

Introduces self 0 1 2 3

Explains what will happen and asks permission to proceed 0 1 2 3

Manages interview without disruptive interruptions 0 1 2 3

Is interested in me, not just my illness 0 1 2 3

Maintains eye contact 0 1 2 3

Body language & tone of voice encourage me to share story 0 1 2 3

Responses to my emotions seem appropriate 0 1 2 3

Inquires about anything else that may be of concern to me 0 1 2 3

Comes to appropriate closure of interview 0 1 2 3

Overall has a professional demeanor 0 1 2 3

Please answer the following questions- Yes or No: Yes No

I believe the “doctor” really sensed or realized what I was feeling.

The “doctor” treated me with respect and courtesy.

I was able to explain my problem to the “doctor” as fully as I needed.

I would want this student participating in the care of a “loved one”

*Please add comments above or on the backside of this form


Name of Student:

Standardized Patient Encounter


Documentation of Patient History
Second Year

HISTORY: Document the history you obtained from the patient. Include identifying patient data,
chief complaint, history of present illness with pertinent positives and negatives, past medical history,
social history and family history, medications, allergies, review of system(s). You may use the back side
if needed.

PRIORITIZED DIFFERENTIAL DIAGNOSES:


PROBLEM LIST: In order of likelihood, list up to 3 diagnoses that might explain
List up to 5 problems elicited this patient’s Chief Complaint (in some cases, fewer than 3
from patient’s presentation diagnoses may be appropriate). Then, enter the positive or
in order of importance: negative findings from the history that support each diagnosis:
1. Diff Diagnosis –
1. Supporting data –

2.
2. Diff Diagnosis –
3. Supporting data –

4.
3. Diff Diagnosis –
5. Supporting data –
Standardized Patient Encounter
Patient Note Scoring Rubric

Student Name:
TOTAL SCORE:
Evaluator: __________________________________

Note Component Patient Note Scoring Anchors


Score
Unacceptable Acceptable Superior
Medical History 1 2 3 4 5 6
Note is disorganized with Organization of note shows Organization of note reflects
Organization elements inappropriately generally ordered approach to ordered approach to case,
interspersed, information is case, with little ambiguity, and information is clear and legible
ambiguous, legibility is poor acceptable legibility

Significant positives or Significant positives/negatives Significant positives/negative


Detail negatives are omitted or are included but may be elements of history are
inappropriately detailed findings inappropriately detailed recognized as such by inclusion
obscure key elements in note

Problem List Problem list is inconsistent Problem list is generally Problem list correctly reflects
with findings or some consistent with findings, but the history in the case
information is lacking some information may be
lacking

Differential Diagnoses Differential diagnoses are Differential diagnoses generally Differential diagnoses are
inconsistent with the history or consistent with the history, but complete and reasonable,
important diagnoses were some are not consistent or supported by the history
not listed some important diagnoses are
not listed

Supporting Key supporting data is not Supporting data appropriately All the reported supporting data
Data listed, or supporting data does supports diagnosis, but some of is listed and appropriately
not support the diagnosis the reported supported data is supports the diagnosis
not included
Student Name: «Last», «First»

Standardized Patient Video Review Self-Assessment

How did you begin the interaction? ___________

_____

_____

What was positive about the interaction and what determined this? ___________

_____

_____

_____

What was negative about this interaction and what determined this? ___________

_____

_____

_____

Do you believe that you elicited the information you needed? YES NO

What would you ask next time? _____ ______

_____

_____

What was the patient’s explanatory model/understanding of her/his problem?

_____

_____

_____

-OVER-
Please rate the following statements on this scale:

1 =weak/done poorly 2 3=moderate/done 4 5 =strong/done well

Communication with the patient was comfortable. 1 2 3 4 5

My use of open-ended questions was appropriate. 1 2 3 4 5

I began the interaction with open ended questions YES ____ NO____

I was able to show empathy with this patient. 1 2 3 4 5

My non-verbal communication was facilitative. 1 2 3 4 5

I was able to use active listening. 1 2 3 4 5

I appeared attentive. YES____ NO____

I appeared distracted. YES____ NO____

I was able to express doubt or uncertainty about what I know. 1 2 3 4 5

As a result of this interaction, do you think that the patient


would choose you as a physician? YES____ NO____

For what reasons have you’ve chosen the particular “troublesome” segment?

_____

_____

_____

What kind of specific help/feedback are you seeking from the group review?

_____

_____

_____

Use the following scale for the following questions:

1-Never 2-Seldom 3-Sometimes 4-Often 5-Always


History Taking Practice with Community Preceptor:
How often were you able to take histories on office/clinic patients?: 1 2 3 4 5

History Taking Practice with Faculty Mentor:


How often were you able to take histories on hospitalized patients?: 1 2 3 4 5
Student Name: «Last», «First» Faculty:__________

Standardized Patient Video Review


Facilitator Assessment of Student Participation in Small Group

Please rate the following according to this scale:


0 – not done 1 – needs improvement 2 – done well

Assessment of the individual student while being reviewed:

Re: The “troublesome” segment


Articulate in describing reasons for choosing 0 1 2
Appropriate choice for evaluation 0 1 2

Re: Attitude toward patient interaction


Valid self-assessment 0 1 2
Too much satisfaction Yes___ No___
Too much self-deprecation Yes___ No___

Re: Feedback
Requested appropriate feedback 0 1 2
Response to feedback 0 1 2

Assessment of the individual student as a group participant:

Re: Observation
Attentive watcher 0 1 2
Attentive listener 0 1 2
Made appropriate observations 0 1 2

Re: Interactions with group


Asked appropriate questions 0 1 2
Valued others’ input 0 1 2
Promoted the group process 0 1 2

Re: Feedback
Provided feedback about specific behavior
[not global feedback] 0 1 2
Was concerned about how it was received 0 1 2

Did the student inhibit or hamper the group process? Yes___ No___

**Please use the space below on this form for comments, noting the student’s strengths
or areas in need of improvement
Student’s Name: «Last», «First»

Faculty Advisor Name: _______________________

Faculty Advisor Report on Student Conference

1=weak/done poorly 3=moderate/done 5=strong/done well

With respect to student’s:

general attitude 1 2 3 4 5

maturity 1 2 3 4 5

comfort level in session 1 2 3 4 5

ability to communicate 1 2 3 4 5

acknowledgement of own strengths 1 2 3 4 5

acknowledgement of own limitations 1 2 3 4 5

willingness to accept feedback 1 2 3 4 5

commitment to developing her/his Development Plan 1 2 3 4 5

Comments, Praise, Concerns:


 

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IV. Supplemental Materials for Standardized Patient History
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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