School of Medicine

KU School of Medicine - Mid-Rotation Feedback

Student: ____________________________ Evaluator:____________________________ Campus: KC W Date:_____________

____ Ambulatory Med./Geriatrics
____ Family Medicine

____ Internal Medicine
____ Neuropsychiatry

____ Obstetrics/Gynecology
____ Pediatrics

____ Surgery
____ Other: ____________________

Competency	Insufficient exposure to evaluate / NA	Borderline Does not meet expectations	Meets expectations	Exceeds expectations	Comments / Learning or Growth Plan
Patient Care: History taking skills, physical exam skills, clinical reasoning, etc.
Medical Knowledge: Applied basic science knowledge, general medical knowledge, knowledge of disease processes, etc.
Practice-based Learning: Interest in and ability for self-evaluation, insight, initiative, use of information resources.
Interpersonal & Communication Skills: Rapport with patients, relationships with staff, listening skills, written communication skills, oral presentations, etc.
Professionalism: Reliability, dependability, honesty, integrity, respect for patients and others, ethics.
Systems-based Practice: Understanding of the role and contribution of health care team members, understanding of the systems of health care.

Strengths:

Areas for Improvement

By signing below you are indicating that the above information was discussed with the student.

Student signature _____________________________________ Evaluator signature _____________________________________