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MINICEXASSESSMENTFORM

StudentName: YearofStudy: Assessor: Year4Year5 Low MediumHigh

DateofAssessment: StudentNo:

AssessorsPosition: Speciality:

JMORegistrarConsultant PatientAge:

PatientProblem: CaseComplexity:

Gender:Male

Female

FocusofAssessment: HistoryTakingExaminationDiagnosticReasoningManagementExplanation Setting:

InpatientOutpatientEmergencyGeneralpracticeOther(pleasespecify)

Toensuresafe,efficientandeffectivecareonthisaspect RequiresSignificant RequiressomeInput PerformsTask Unableto InputfromSupervisor fromSupervisor Independently Assess Interactswellwithpatient;Directsquestionsatkeyproblems;Usessecondorderof questioningtorefinefocus;Integratesinformationfromquestions;Observesand respondsappropriatelytononverbalcues;Considersarangeofdiagnosticoptions; Takesahistoryappropriatetotheclinicalsituation

ASSESSMENT
Medicalinterviewingskills

1 Physicalexaminationskills

UTA

Conductsasystematicandstructuredphysicalexamination;Showssensitivityto patientscomfortandmodesty;Detectsabnormalsignswhenpresentandassessesthe significanceofthesefindings;Getsinformedconsent;Focusestheexaminationonthe mostimportantcomponents;Integratesfindingsonexaminationwithotherinformation toclarifydiagnosis

1 Professionalqualities/communication

UTA

Showsrespectforpatient;Explainsaswellasasks;Listensaswellastells;Awareof potentiallyembarrassingorpainfulcomponentsofinteraction;Respectspatient confidentiality;Abletoadaptquestioningandexaminationtopatientsresponses; Presentsclinicalinformationinaclearandcoherentmanner

1 Patienteducation

UTA

Explainsrationaletest/treatment;Providesinformationinawaythatisclearand tailoredtothepatientsneeds;Respondstopatientandmodifiesorrepeatsinformation whenappropriate;Listenstopatientswishes;Avoidspersonalopinionandbias

1 Clinicaljudgement

UTA

Weighsimportanceofpotentiallyconflictingclinicaldata;Determinesappropriate choiceofinvestigationsandmanagement;Relatesmanagementoptionstothepatients ownwishesorcontext;Considerstherisksandbenefitsofthechosenmanagement/ treatmentoptions;Comestoafirmdecisionbasedonavailableevidence

1 Organisation/efficiency

UTA

Synthesisesacollectionofdataquicklyandefficiently;Usesappropriatejudgementand synthesis;Demonstratesoptimaluseoftimeincollectionofclinicalandinvestigational data

UTA

OVERALLPERFORMANCEFORTHISPROCEDURE
Whatlevelofsupervisiondidthestudent requireforTHISprocedure(pleasetick):
RequiresSignificantInput fromSupervisor RequiressomeInputfrom Supervisor PerformsTask Independently

AssessormustcompleteGlobalPerformanceonPage2pleaseturnover

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MINICEXASSESSMENTFORM

GLOBALPERFORMANCEFORTHISPROCEDURE(pleasetick)

Unsatisfactory
Gapsinknowledgeorskillsthatyouwouldnotexpectatthisstageofthecourse.Concernaboutprofessionalandpatient safety.

Satisfactory
Standardyouwouldexpectforastudentatthislevelatthisstageofthecourse.Generallyclinicalcompetentwith satisfactorycommunicationskillsandprofessionalism.

Excellent
Performingwellabovethestudentsexpectedlevel.Noconcernsabouttheirclinicalmethod,professionalism, organization,communicationetc.

TIMETAKENFOROBSERVATION: TIMETAKENFORFEEDBACK:

AssessorsCommentsontheStudentsStrengths:

AssessorsSuggestionsforStudentsAreaofImprovement:

StudentsSignature

AssessorsSignature

Date

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