OHSU Department of Psychiatry
Student Evaluation

To be completed by faculty who participated in supervising the medical student.
For questions, contact Kim Taylor, Medical Student Education Coordinator
Phone: (503)494-1114, Fax: (503)494-6152


Student Name:

Clinical Location:
 Evaluator Name:

Evaluator Email:

Please indicate on a 5-point scale how this student has performed in each of the following clinical areas.

-1-
FAIL
Major deficiencies, disorganized, inadequate performance and knowledge

-2-
MARGINAL
Some omissions,limited knowledge and performance,in need of remediation in some areas

 -3-
SATISFACTORY
Major points covered, adequate knowledge and performance, no need for remediation		 -4-
NEAR HONORS
Above average in accuracy, depth, knowledge and performance; among top 50%		 -5-
HONORS
Thorough, detailed and extensive knowledge,expert technique; among top 25%

MARK A SCORE FOR EACH CATEGORY
I. Data Collection, Integration and Management
  1. History Taking

    2. 1 2 3 4 5

  2. Mental Status Exam

    3. 1 2 3 4 5

  3. Physical Exam

    4. 1 2 3 4 5

  4. Clinical Formulation

    5. 1 2 3 4 5

  5. Data Presentation and Documentation

    6. 1 2 3 4 5

III. Professional Development and Interpersonal Skills

  1. Rapport with Patients

    2. 1 2 3 4 5

  2. Rapport with Other Team Members

    3. 1 2 3 4 5

  3. Motivation and Responsibility

    4. 1 2 3 4 5
II. Clinical Knowledge
  1. Differential Diagnosis of Major Mental Illnesses and Personality Disorders

    2. 1 2 3 4 5

  2. Knowledge of Medications; Effects and Side Effects

    3. 1 2 3 4 5

  3. Integration of Medical and Psychiatric Illnesses

    4. 1 2 3 4 5

IV. Overall Clinical Grade
(check one box)

Fail (1) (1.5)

Marginal (2) (2.5)

Satisfactory (3) (3.5)

Near Honors (4) (4.5)

Honors (5)

V. Comments, examples, critical incidents (narrative required for Dean's letter):

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