Mindanao State University – College of Medicine

EVALUATION FORM – ORAL EXAM

Name of student: ____________________________________ Module ________________________ Date Evaluated: ___________

1) Synthesis of Data
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-Not able to highlight any risk factor/s and
symptoms of the disease/s involved from the
history provided
- Not able to identify normal vs abnormal PE
findings relevant to the case
- ROS findings not incorporated
- Able to highlight some of the risk factor/s and symptoms of the
disease/s involved from the history provided
- Able to identify some normal vs abnormal PE findings relevant to
the case; some important findings missed
- Some pertinent findings in the ROS incorporated
- Able to highlight all the risk factor/s and
symptoms of the disease/s involved from the
history provided
- Able to identify all normal vs abnormal PE findings
relevant to the case
- All pertinent findings in the ROS incorporated

2) Formulation of Problem List

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- Most of the case’s medical problems not - Some medical problems omitted from the problem list - Able to present a comprehensive problem list
identified - Some improvement needed in organizing and prioritizing the including all medical problems
- Problem list presented in a disorganized manner problem list - Able to organize the problem list well by degree of
with poor prioritization urgency

3) Initial Working Diagnosis

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- Incorrect diagnosis and basis for diagnosis
incorrect
- Assessment not consistent with data presented
- Fails to clearly justify diagnosis or note
secondary problems or orders inappropriate
diagnostic tests
- Assessment occasionally
consistent with data presented
- can occasionally justify
diagnosis or note secondary
problems
- Assessment consistent with - Assessment consistent with prior documentation;
data presented Clear justification for diagnosis;
- Clear justification for diagnosis; - Notes all secondary problems;
Notes most secondary problems.

4) Formulation of Differential Diagnoses

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- Almost no differential diagnoses formulated - Some differential diagnoses provided; a few major ddx missed - Multiple differential diagnoses provided with good
- Ddx with no/poor correlation with history and - Some Ddx not well correlated to history and PE findings plausibility ;
PE findings - All differential diagnoses correlated to pertinent
history and PE findings
 5) Management – Initial Diagnostics and Emergency Management
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- No essential workup ordered - Ordered some of the essential workup - Ordered all essential diagnostic work-up
- Unable to explain rationale and expected - Improvement needed in rationale and expected findings - Adequately explained rationale, limitations, and
findings for tests - Some unnecessary tests ordered expected findings for tests ordered
- Most diagnostics do not correlate with working - Some improvement needed in prioritizing urgent diagnostics - Able to recognize which tests to prioritize on
impression and ddx - Some urgent/STAT interventions not ordered emergency basis
- Unable to prioritize diagnostics by urgency - Cost effective when ordering diagnostic tests
- Not able to provide urgent/STAT interventions - Able to order all urgent/STAT interventions
needed at ER level needed at ER level
6) Interpretation of Diagnostic Tests
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- Not able to correctly interpret most of the lab - Able to correctly interpret some of the lab results provided - Able to correctly interpret all lab results provided
results provided - Some improvement needed in revision of working diagnoses; some - Able to revise working diagnoses and narrow
- Working diagnoses not revised and none of the ddx not ruled out/confirmed despite results provided down ddx based on the results provided
ddx ruled out/ confirmed despite results provided
7) Management – Non-pharmacologic
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- Almost none ordered - Some non-pharmacologic intervention given - All important non-pharmacologic interventions
- Provided no warning signs/symptoms to watch - Provided some warning signs/symptoms to watch out for during ordered
out for during monitoring monitoring - Able to identify warning signs/symptoms to watch
- Unable to recognize need for specialist referral - Some improvement needed in recognizing need for specialist out for during monitoring
referrals - Appropriate specialist referrals
8) Management – Pharmacologic
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- Interventions do not correlate with working dx - Some interventions lacking or some inappropriate treatment given - Good correlation between treatment ordered and
- Unable to explain the rationale and side effects - Some improvement needed in explaining the rationale of diagnosis
of interventions interventions - Good grasp of the pharmacology behind
- Lack of prioritization of emergent treatment - Some improvement needed in prioritization of treatment interventions ordered
- Able to prioritize emergent intervention
9) Professionalism and Conduct
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- Lacks confidence and proper articulation - Some improvement needed in confidence and articulation - Shows appropriate confidence and good
- Presents the case in an informal, unprofessional - Occasionally bluffs responses to questions; some prompting / articulation
manner coaching needed -Maintains professional composure
- Unable to answer any questions without - Recognizes faults and limitations when unable to
coaching / prompting answer questions
TOTAL GRADE = ____ / 90 = _____ % (Passing Grade: 60%) Additional Comment/s: (Please write N/A if not applicable)
Consultant Evaluator __________________________ ________________________________________________________________
(Signature over Printed Name)