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  1. University of Arkansas for Medical Sciences
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  6. Student Feedback Form

Student Feedback Form

Directly Observed Clinical Care Feedback Form

Student Name(Required)
Faculty or Resident Name(Required)

Please complete only the sections of this form that you directly observed. Leave any areas you did not observe blank.

Effectiveness, pertinent details, organization and coherence
Ability to identify organ system exams relevant to chief concern / chronic disease – accuracy of exam technique, ability to identify abnormal findings without prompting
  1. Generates an appropriate and prioritized DD based on history, exam findings and pre-existing data – prior labs/imaging results
  2. Recognizes most likely diagnoses
  3. Includes relevant “do not miss” or serious life-threatening conditions and effectively excludes serious conditions through appropriate clinical reasoning/diagnostic work up/ treatment and follow up plan
Recognizes first test and next best steps in diagnosing and managing a suspected clinical problem.
  1. Appropriate knowledge of relevant pathophysiology of disease process, drug classes, clinical indication and contraindications of commonly prescribed drugs
  2. Uses knowledge of clinical pathophysiology and pharmacology to suggest diagnostic / treatment plan
Functions as a great team player, displays proactiveness and assists residents and primary care team members in providing patient education and communicates well with team members.
Acknowledgement(Required)
I have discussed the above feedback with the student and suggested a plan for further enhancement of knowledge and skills for practice of Family Medicine.
Date of Acknowledgement(Required)
UAMS College of Medicine LogoUAMS College of MedicineUniversity of Arkansas for Medical Sciences
Mailing Address: 4301 West Markham Street, Little Rock, AR 72205
Phone: (501) 686-7000
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