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    CEX Form

    Uploaded by

    fredajw90
    This document is a clinical evaluation form used to assess a medical student during their clinical clerkship. It evaluates the student on their history taking, physical exam, communication, medical knowledge and clinical judgment, management skills, and professionalism when interacting with patients. The evaluator rates the student on a scale of 1 to 5 on criteria within each of these categories and provides comments on any areas that received a score of 1 or 5. It also calculates an overall performance score for the student based on their total points across all criteria.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    CEX Form

    Uploaded by

    fredajw90
    83 views3 pages
    This document is a clinical evaluation form used to assess a medical student during their clinical clerkship. It evaluates the student on their history taking, physical exam, communication, medical knowledge and clinical judgment, management skills, and professionalism when interacting with patients. The evaluator rates the student on a scale of 1 to 5 on criteria within each of these categories and provides comments on any areas that received a score of 1 or 5. It also calculates an overall performance score for the student based on their total points across all criteria.

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    eval form

    Original Title

    CEX form

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    This document is a clinical evaluation form used to assess a medical student during their clinical clerkship. It evaluates the student on their history taking, physical exam, communication, medical knowledge and clinical judgment, management skills, and professionalism when interacting with patients. The evaluator rates the student on a scale of 1 to 5 on criteria within each of these categories and provides comments on any areas that received a score of 1 or 5. It also calculates an overall performance score for the student based on their total points across all criteria.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    83 views3 pages

    CEX Form

    Uploaded by

    fredajw90
    This document is a clinical evaluation form used to assess a medical student during their clinical clerkship. It evaluates the student on their history taking, physical exam, communication, medical knowledge and clinical judgment, management skills, and professionalism when interacting with patients. The evaluator rates the student on a scale of 1 to 5 on criteria within each of these categories and provides comments on any areas that received a score of 1 or 5. It also calculates an overall performance score for the student based on their total points across all criteria.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Clinical Evaluation Exercise (CEX) Form

    Name of Student: Student Registration


    No.:
    Name of Evaluator: Date of Assessment:

    Forms - Clinical Evaluation Exercise CEX - Clinical Clerkship ver2 4 - 28 Jul 2010.doc Page 1 of 3
    *Please indicate as appropriate or tick () in the appropriate box:
    SGH KKH
    Medicine Surgery OBGyn Paediatrics
    IMH NNI-SGH
    CGH NNI-TTSH
    Clerkship:*
    Neurology Psychiatry
    Family
    Medicine

    Medical
    Institution:*
    Others (specify):
    ___ / ___ / ______ ___ / ___ / ______
    Period of
    Posting:*
    dd / mm / yyyy
    to
    dd / mm / yyyy

    Senior Consultant Consultant Associate Consultant Registrar
    Evaluators
    Designation:*
    Medical Officer Others (specify):
    General Ward Clinic ICU / ICA / HD / SCN OT
    Location(s):*
    Emergency Dept Others (specify):

    Based on a scale of 1 to 5, rate the degree to which the student meets the listed criterion.
    1 2 3 4 5 N

    Does not meet
    expectations

    Meets
    expectations

    Exceeds
    expectations
    Not
    observed


    (A) History Taking
    Please circle the appropriate number
    Establishes and maintains rapport with patient. 1 2 3 4 5 N
    Takes focused history of present illness/condition. 1 2 3 4 5 N
    Takes focused history of relevant previous medical / surgical history. 1 2 3 4 5 N
    Directs appropriate questions to gather social / family history of patient. 1 2 3 4 5 N
    Controls / guides the flow of the interview. 1 2 3 4 5 N

    Evaluators comments (Please comment, if student has scored 1 or 5 in any of the above)




    (B) Physical Exam
    Please circle the appropriate number
    Follows an efficient and logical sequence when examining patient and completes
    the examination.
    1 2 3 4 5 N
    Selects examination technique appropriate for patients illness/condition. 1 2 3 4 5 N
    Attends appropriately to patients modesty and comfort. 1 2 3 4 5 N
    Identifies major and minor findings. 1 2 3 4 5 N

    Evaluators comments (Please comment, if student has scored 1 or 5 in any of the above)




    Clinical Evaluation Exercise (CEX) Form

    Name of Student: Student Registration
    No.:
    Name of Evaluator: Date of Assessment:

    Forms - Clinical Evaluation Exercise CEX - Clinical Clerkship ver2 4 - 28 Jul 2010.doc Page 2 of 3
    (C) Communications
    Please circle the appropriate number
    Presents case comprehensively and sequentially in the correct and logical context. 1 2 3 4 5 N
    Writes in problem-oriented documentation of patients encounter with legible
    handwriting.
    1 2 3 4 5 N
    Able to communicate major content effectively with patient / relative and ensuring
    their understanding.
    1 2 3 4 5 N

    Evaluators comments (Please comment, if student has scored 1 or 5 in any of the above)




    (D) Knowledge & Clinical Judgment
    Please circle the appropriate number
    Able to relate patients symptom to the disease process. 1 2 3 4 5 N
    Able to formulate differential diagnosis appropriate to the patients medical
    problem(s).
    1 2 3 4 5 N
    Able to plan diagnostic test(s) appropriate to the patients medical problem(s). 1 2 3 4 5 N
    Possesses good theoretical knowledge (including integrating basic science) and
    applies it into diagnostic plan and treatment options.
    1 2 3 4 5 N

    Evaluators comments (Please comment, if student has scored 1 or 5 in any of the above)




    (E) Management
    Please circle the appropriate number
    Able to develop a treatment plan by identifying the principles of management. 1 2 3 4 5 N

    Evaluators comments (Please comment, if student has scored 1 or 5 in any of the above)



    (F) Professionalism
    Please circle the appropriate number
    Exhibits flexibility and openness to feedback and self-improvement. 1 2 3 4 5 N
    Takes pride in establishing a caring and trusting relationship with the patient. 1 2 3 4 5 N
    Aware of the ethical and professional issues in the patients management. 1 2 3 4 5 N

    Evaluators comments (Please comment, if student has scored 1 or 5 in any of the above)




    Clinical Evaluation Exercise (CEX) Form

    Name of Student: Student Registration
    No.:
    Name of Evaluator: Date of Assessment:

    Forms - Clinical Evaluation Exercise CEX - Clinical Clerkship ver2 4 - 28 Jul 2010.doc Page 3 of 3
    (G) Students Overall Performance

    total points scored in all six sections
    Overall Score =
    (no. of OBSERVED criteria) x 5 (max. no. of points)
    x 100% = %

    (Comments are required for overall score of less than 40%, outlining specific areas of deficiencies, remediation
    strategies, and areas of improvement. Overall, make recommendations for areas in which student can improve.)
    Evaluators Comments





    Signature and Name Stamp of Evaluator Date

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