Professional Documents
Culture Documents
Examination Mini-CEX Form 22
Examination Mini-CEX Form 22
Examination
Student’s name: ......................................................... Date of assessment: _ /__/_____
Patient problem/ Diagnosis: .........................................................................................................................
Patient gender: Male / Female Patient age: .........
Done Not
0.25 0
Communication - Introduces one's self and confirm patient name
0.5 0.25 0
Feedback (by Clinical Tutor) Learning agenda derived from case discussion that
What went well: ………………………………………………………….. will help student to improve his theoretical
…………………………………………………………………………………….. background:
…………………………………………………………………………………….. 1. ……………………………………………………
What can be done in different way: ……………………………………………………
……………………………………………………………………………………. 2. ……………………………………………………
……………………………………………………………………………………. ……………………………………………………
……………………………………………………………………………………. 3. ……………………………………………………
……………………………………………………………………………………. ……………………………………………………
Assessor signature: