Phase 3a 2016Placement Based Assessment

This is an observed examination and examination regulations apply.

The assessment should take place during the penultimate week of the attachment.

Please read the following carefully.

Child Health - Observed Long Case - 45 minutes

Instructions for the examiner

1. The patient must be selected by the examiner before the start of the assessment and have had no previous contact with, or knowledge of, the candidate.

2. The complexity of the case must be taken into account when forming a judgement about the students’ competence.3. At no point whilst the candidate is taking the history, should the examiner interact with the candidate or patient unless

the examiner has any concerns about the welfare of either the patient or the student. After completion of the history the candidate should be invited to present the history without interruption or guidance from the examiner. Following this the candidate should be asked what focussed and appropriate examinations they wish to perform to help in their assessment of the patient and the formulation of a differential diagnosis.

4. Questions to the student should relate only to the case in question ie diagnosis, investigations, treatment, management plan, as indicated by the module’s “Guidance for Examiners”. Please do not ask any additional questions of the student.

5. Although you may have observed the students’ performance during their attachment please avoid using any other previous interaction with them as evidence of satisfactory performance in this assessment.

6. Please ensure that you follow the instructions relating to the module’s “Guidance for Examiners”. Thank you for your help with this matter.

Completing the attached form

1. Please adhere to notes on the detail of the domains which is given on the reverse of the placement based assessment form.

2. All relevant domains must be graded in accordance with the scale and the level of expected attainment of a 3a student. Phase 3a students are between 2.5 – 3.5 years through a 5 year degree programme.

3. The final judgement is binary – please indicate either “pass” or “fail”.4. Students’ value feedback on their performance as it facilitates their continued educational development. Those who

perform satisfactorily may require reassurance that their skills and knowledge are adequate whilst praising good performance is also most helpful. For poor performance the areas of weakness must be constructively discussed and a method of improving subsequent performance agreed with the student.

5. Please sign the form and supply your details as indicated.6. The form must be returned promptly to the appropriate member of the administrative staff.

The Medical School.

Registration Number

Phase 3a Summative Clinical Assessment FormObserved LONG CaseIs this a second attempt? YES □ NO □ (tick as appropriate)

NB use black ink only

CHILD HEALTH2016

Student Name Date

Brief case summary Focus of encounter

History □Examination □

ASSESSMENTGrade the following againstthe standard expected for a3a student

NAWell below the

standard expected of a

3a student

Below the standard

expected of a 3a student

Standard expected of a

3a student

Above the standard

expected of a 3a student

Well above the standard expected of a

3a student

History □ □ □ □ □ □Examination □ □ □ □ □ □Clinical Reasoning Skills □ □ □ □ □ □Professional Behaviour □ □ □ □ □ □

Global Rating Fail □ Pass □

FEEDBACKGood or excellent performance Areas requiring attention

Assessors detailsName(please print)

Grade

Signature Date

Email

Return form to Joanne O’Leary Academic Unit of Child Health, Stephenson Wing, Sheffield Children’s Hospital, Western Bank

TheMedicalSchool

NotesHistoryMedical Interviewing and Communication Skills. Facilitates patient’s telling of history & volunteering of information; effectively uses open and closed questions to obtain accurate, adequate information; responds appropriately to affect and non-verbal cues.ExaminationFollows efficient, logical sequence with appropriate questioning to elicit phenomenology; balances screening/diagnostic questions for the problem; conducts the examination sensitivelyClinical Reasoning SkillsDemonstrates good judgeement, synthesis and sifting of information in a focused way; is efficient and safe; knows limitations of personal competence and knows when to request help; is able to formulate a differential diagnosis, discuss appropriate investigations, and plans for immediate management, including risks and benefits.Professional BehaviourIntroduces self appropriately, washes hands, shows respect, compassion, empathy, establishes trust; attends to patient’s needs and respects patient confidentiality, chooses an appropriate environment for the interview, is aware of and sensitive to the patient's cultural background.

Phase 3a 2016Placement Based Assessment

This is an observed examination and examination regulations apply.

The assessment should take place during the penultimate week of the attachment.

Please read the following carefully.

Child Health - Observed Short Case 1 & 2 - 15 minutes only

Instructions for the examiner

1. The patient must be selected by the examiner before the start of the assessment and have had no previous contact with, or knowledge of, the candidate.

2. The complexity of the case must be taken into account when forming a judgement about the students’ competence.3. At no point should the examiner interact with the candidate or patient during the assessment unless the examiner has

any concerns about the welfare of either the patient or the student.4. Questions to the student should relate only to the case in question ie diagnosis, investigations, treatment,

management plan, as indicated by the module’s “Guidance for Examiners”. Please do not ask any additional questions of the student.

5. Although you may have observed the students’ performance during their attachment please avoid using any other previous interaction with them as evidence of satisfactory performance in this assessment.

6. Please ensure that you follow the instructions relating to the conduct of examiners. Thank you for your help with this matter.

Completing the attached form

1. Please adhere to guidance on the detail of the domains which is given on the reverse of the placement based assessment form.

2. All relevant domains must be graded in accordance with the scale and the level of expected attainment of a 3a student. . Phase 3a students are between 2.5 – 3.5 years through a 5 year degree programme.Please see https://www.minervashef.ac.uk/medfac/minerva/phase3a/child_health_videos/introStandard of Examination required for a Phase 3a student.

3. The final judgement is binary – please indicate either “pass” or “fail”.4. Students’ value feedback on their performance as it facilitates their continued educational development. Students

who perform satisfactorily may not have the same perception of their performance as you do and may require reassurance that their skills and knowledge are adequate. Praising good performance is also most helpful to students. Poor performance should not be criticised in a destructive or humiliating manner; rather the areas of weakness must be discussed and a method of improving subsequent performance agreed with the student.

5. Please sign the form and supply your details as indicated.6. The form must be returned promptly to the appropriate member of the administrative staff.

Registration Number

TheMedicalSchool

The Medical School.

Phase 3a Summative Clinical Assessment FormObserved SHORT Case 1Is this a second attempt? YES □ NO □ (tick as appropriate)

NB use black ink only

CHILD HEALTH2016

Student Name Date

Brief case summary Focus of encounter

History □Examination □

ASSESSMENTGrade the following againstthe standard expected for a3a student

NAWell below the

standard expected of a

3a student

Below the standard

expected of a 3a student

Standard expected of a

3a student

Above the standard

expected of a 3a student

Well above the standard expected of a

3a student

History □ □ □ □ □ □Examination □ □ □ □ □ □Clinical Reasoning Skills □ □ □ □ □ □Professional Behaviour □ □ □ □ □ □

Global Rating Fail □ Pass □

FEEDBACKGood or excellent performance Areas requiring attention

Assessor’s detailsName(please print)

Grade

Signature Date

Email

Return form to Joanne O’Leary Academic Unit of Child Health, Stephenson Wing, Sheffield Children’s Hospital, Western Bank

NotesHistoryMedical Interviewing and Communication Skills. Facilitates patient’s telling of history & volunteering of information; effectively uses open and closed questions to obtain accurate, adequate information; responds appropriately to affect and non-verbal cues.ExaminationFollows efficient, logical sequence with appropriate questioning to elicit phenomenology; balances screening/diagnostic questions for the problem; conducts the examination sensitivelyDecision Making SkillsDemonstrates good judgement, synthesis and sifting of information in a focused way; is efficient and safe; knows limitations of personal competence and knows when to request help; is able to formulate a differential diagnosis, discuss appropriate investigations, and plans for immediate management, including risks and benefits.Professional BehaviourIntroduces self appropriately, washes hands, shows respect, compassion, empathy, establishes trust; attends to patient’s needs and respects patient confidentiality, chooses an appropriate environment for the interview, is aware of and sensitive to the patient's cultural background.

Registration Number

Phase 3a Summative Clinical Assessment FormObserved SHORT Case 2Is this a second attempt? YES □ NO □ (tick as appropriate)

NB use black ink only

CHILD HEALTH2016

Student Name Date

Brief case summary Focus of encounter

History □Examination □

ASSESSMENTGrade the following againstthe standard expected for a3a student

NAWell below the

standard expected of a

3a student

Below the standard

expected of a 3a student

Standard expected of a

3a student

Above the standard

expected of a 3a student

Well above the standard expected of a

3a student

History □ □ □ □ □ □Examination □ □ □ □ □ □Clinical Reasoning Skills □ □ □ □ □ □Professional Behaviour □ □ □ □ □ □

Global Rating Fail □ Pass □

FEEDBACKGood or excellent performance Areas requiring attention

Assessor’s detailsName(please print)

Grade

Signature Date

Email

Return form to Joanne O’Leary Academic Unit of Child Health, Stephenson Wing, Sheffield Children’s Hospital, Western Bank

TheMedicalSchool

NotesHistoryMedical Interviewing and Communication Skills. Facilitates patient’s telling of history & volunteering of information; effectively uses open and closed questions to obtain accurate, adequate information; responds appropriately to affect and non-verbal cues.ExaminationFollows efficient, logical sequence with appropriate questioning to elicit phenomenology; balances screening/diagnostic questions for the problem; conducts the examination sensitivelyDecision Making SkillsDemonstrates good judgement, synthesis and sifting of information in a focused way; is efficient and safe; knows limitations of personal competence and knows when to request help; is able to formulate a differential diagnosis, discuss appropriate investigations, and plans for immediate management, including risks and benefits.Professional BehaviourIntroduces self appropriately, washes hands, shows respect, compassion, empathy, establishes trust; attends to patient’s needs and respects patient confidentiality, chooses an appropriate environment for the interview, is aware of and sensitive to the patient's cultural background.

Phase 3a 2016Placement Based Assessment

This is an observed examination and examination regulations apply.

The assessment should take place during the penultimate week of the attachment.

Please read the following carefully.

Psychiatry - Observed Long Case - one hour only

Guidance for the examiner

1. The patient must be selected by the examiner before the start of the assessment and have had no previous contact with, or knowledge of, the candidate.

2. The complexity of the case must be taken into account when forming a judgement about the students’ competence.3. At no point should the examiner interact with the candidate or patient during the assessment unless the examiner has

any concerns about the welfare of either the patient or the student.4. Questions to the student should relate only to the case in question ie diagnosis, investigations, treatment, management

plan, as indicated by the module’s “Guidance for Examiners”. Please do not ask any additional questions of the student.

5. Although you may have observed the students’ performance during their attachment please avoid using any other previous interaction with them as evidence of satisfactory performance in this assessment.

6. Please ensure that you follow the instructions relating to the module’s “Guidance for Examiners”. Thank you for your help with this matter.

Completing the attached form

1. Please adhere to guidance on the detail of the domains which is given on the reverse of the placement based assessment form.

2. All relevant domains must be graded in accordance with the scale and the level of expected attainment of a 3a student.3. The final judgement is binary – please indicate either “pass” or “fail”.4. Students’ value feedback on their performance as it facilitates their continued educational development. Those who

perform satisfactorily may require reassurance that their skills and knowledge are adequate whilst praising good performance is also most helpful. For poor performance the areas of weakness must be constructively discussed and a method of improving subsequent performance agreed with the student.

5. Please sign the form and supply your details as indicated.6. The form must be returned promptly to the appropriate member of the administrative staff.

The Medical School.

Registration Number

Phase 3a Summative Clinical Assessment FormObserved LONG CaseIs this a second attempt? YES □ NO □ (tick as appropriate)NB use black ink only

PSYCHIATRY 2016

Student Name Date

Brief case summary

Grade the following where appropriate at the standard expected of a 3a student

Well below the standard expected of a

3a student

Below the standard

expected of a 3a student

Standard expected of a

3a student

Above the standard

expected of a 3a student

Well above the standard expected of a

3a studentHistoryIntroduction and establishment of rapportSystematic approachAll relevant elements of history elicited

□ □ □ □ □Mental State ExaminationSystematic approachComprehensive psychopathology elicited

□ □ □ □ □Physical ExaminationComments on relevant physical examinations □ □ □ □ □FormulationDifferential diagnosesJustification of differential diagnosesAetiology and Prognosis

□ □ □ □ □Risk Assessment □ □ □ □ □ManagementInvestigationsManagement plans

□ □ □ □ □Professional Behaviours □ □ □ □ □Global Rating Fail □ Pass □FeedbackGood / Excellent Performance Areas requiring attention

Assessor’s Name (please print) Assessor’s email

Return form to Ms S Turvey, Academic Psychiatry, The Medical School, Beech Hill Road, Sheffield, S10 2RX

TheMedicalSchool.

Phase 3a 2016Placement Based Assessment

This is an observed examination and examination regulations apply.

The assessment should take place during the penultimate week of the attachment.

Please read the following carefully.

Women’s Health - Observed Long Case - one hour only

Guidance for the examiner

1. The patient must be selected by the examiner before the start of the assessment and have had no previous contact with, or knowledge of, the candidate.

2. The complexity of the case must be taken into account when forming a judgement about the students’ competence.3. At no point should the examiner interact with the candidate or patient during the assessment unless the examiner has

any concerns about the welfare of either the patient or the student.4. Questions to the student should relate only to the case in question ie diagnosis, investigations, treatment, management

plan, as indicated by the module’s “Guidance for Examiners”. Please do not ask any additional questions of the student.

5. Although you may have observed the students’ performance during their attachment please avoid using any other previous interaction with them as evidence of satisfactory performance in this assessment.

6. Please ensure that you follow the instructions relating to the module’s “Guidance for Examiners”. Thank you for your help with this matter.

Completing the attached form

1. Please adhere to guidance on the detail of the domains which is given on the reverse of the placement based assessment form.

2. All relevant domains must be graded in accordance with the scale and the level of expected attainment of a 3a student.3. The final judgement is binary – please indicate either “pass” or “fail”.4. Students’ value feedback on their performance as it facilitates their continued educational development. Those who

perform satisfactorily may require reassurance that their skills and knowledge are adequate whilst praising good performance is also most helpful. For poor performance the areas of weakness must be constructively discussed and a method of improving subsequent performance agreed with the student.

5. Please sign the form and supply your details as indicated.6. The form must be returned promptly to the appropriate member of the administrative staff.

The Medical School.

Registration Number

Phase 3a Summative Clinical Assessment FormObserved LONG CaseIs this a second attempt? YES □ NO □ (tick as appropriate)

NB use black ink only

WOMEN’S HEALTH2016

Student Name Date

Brief case summary Focus of encounter

History □Examination □

ASSESSMENTGrade the following againstthe standard expected for a3a student

NAWell below the

standard expected of a

3a student

Below the standard

expected of a 3a student

Standard expected of a

3a student

Above the standard

expected of a 3a student

Well above the standard expected of a

3a student

History □ □ □ □ □ □Examination □ □ □ □ □ □Clinical Reasoning Skills □ □ □ □ □ □Professional Behaviour □ □ □ □ □ □

Global Rating Fail □ Pass □

FEEDBACKGood or excellent performance Areas requiring attention

Assessors detailsName(please print)

Grade

Signature Date

Email

Return form to Mrs G Burkinshaw, Reproduction and Developmental Medicine, Jessop Wing, Tree Root Walk, Sheffield

TheMedicalSchool

NotesHistoryMedical Interviewing and Communication Skills. Facilitates patient’s telling of history & volunteering of information; effectively uses open and closed questions to obtain accurate, adequate information; responds appropriately to affect and non-verbal cues.ExaminationFollows efficient, logical sequence with appropriate questioning to elicit phenomenology; balances screening/diagnostic questions for the problem; conducts the examination sensitivelyDecision Making SkillsDemonstrates good judgement, synthesis and sifting of information in a focused way; is efficient and safe; knows limitations of personal competence and knows when to request help; is able to formulate a differential diagnosis, discuss appropriate investigations, and plans for immediate management, including risks and benefits.Professional BehaviourIntroduces self appropriately, washes hands, shows respect, compassion, empathy, establishes trust; attends to patient’s needs and respects patient confidentiality, chooses an appropriate environment for the interview, is aware of and sensitive to the patient's cultural background.

Phase 3a 2016Placement Based Assessment

This is an observed examination and examination regulations apply.

The assessment should take place during the penultimate week of the attachment.

Please read the following carefully.

Women’s Health - Observed Short Case - 20 minutes only

Guidance for the examiner

1. The patient must be selected by the examiner before the start of the assessment and have had no previous contact with, or knowledge of, the candidate.

2. The complexity of the case must be taken into account when forming a judgement about the students’ competence.3. At no point should the examiner interact with the candidate or patient during the assessment unless the examiner has

any concerns about the welfare of either the patient or the student.4. Questions to the student should relate only to the case in question ie diagnosis, investigations, treatment,

management plan, as indicated by the module’s “Guidance for Examiners”. Please do not ask any additional questions of the student.

5. Although you may have observed the students’ performance during their attachment please avoid using any other previous interaction with them as evidence of satisfactory performance in this assessment.

6. Please ensure that you follow the instructions relating to the conduct of examiners. Thank you for your help with this matter.

Completing the attached form

1. Please adhere to guidance on the detail of the domains which is given on the reverse of the placement based assessment form.

2. All relevant domains must be graded in accordance with the scale and the level of expected attainment of a 3a student.

3. The final judgement is binary – please indicate either “pass” or “fail”.4. Students’ value feedback on their performance as it facilitates their continued educational development. Students

who perform satisfactorily may not have the same perception of their performance as you do and may require reassurance that their skills and knowledge are adequate. Praising good performance is also most helpful to students. Poor performance should not be criticised in a destructive or humiliating manner; rather the areas of weakness must be discussed and a method of improving subsequent performance agreed with the student.

5. Please sign the form and supply your details as indicated.6. The form must be returned promptly to the appropriate member of the administrative staff.

The Medical School.

Registration Number

Phase 3a Summative Clinical Assessment FormObserved SHORT Case 1Is this a second attempt? YES □ NO □ (tick as appropriate)

NB use black ink only

WOMEN’S HEALTH2016

Student Name Date

Brief case summary Focus of encounter

History □Examination □

ASSESSMENTGrade the following againstthe standard expected for a3a student

NAWell below the

standard expected of a

3a student

Below the standard

expected of a 3a student

Standard expected of a

3a student

Above the standard

expected of a 3a student

Well above the standard expected of a

3a student

History □ □ □ □ □ □Examination □ □ □ □ □ □Clinical Reasoning Skills □ □ □ □ □ □Professional Behaviour □ □ □ □ □ □

Global Rating Fail □ Pass □

FEEDBACKGood or excellent performance Areas requiring attention

Assessors detailsName(please print)

Grade

Signature Date

Email

Return form to Mrs G Burkinshaw, Reproduction and Developmental Medicine, Jessop Wing, Tree Root Walk, Sheffield

TheMedicalSchool

NotesHistoryMedical Interviewing and Communication Skills. Facilitates patient’s telling of history & volunteering of information; effectively uses open and closed questions to obtain accurate, adequate information; responds appropriately to affect and non-verbal cues.ExaminationFollows efficient, logical sequence with appropriate questioning to elicit phenomenology; balances screening/diagnostic questions for the problem; conducts the examination sensitivelyDecision Making SkillsDemonstrates good judgement, synthesis and sifting of information in a focused way; is efficient and safe; knows limitations of personal competence and knows when to request help; is able to formulate a differential diagnosis, discuss appropriate investigations, and plans for immediate management, including risks and benefits.Professional BehaviourIntroduces self appropriately, washes hands, shows respect, compassion, empathy, establishes trust; attends to patient’s needs and respects patient confidentiality, chooses an appropriate environment for the interview, is aware of and sensitive to the patient's cultural background.

Phase 3a 2016Placement Based Assessment

This is an observed examination and examination regulations apply.

The assessment should take place during the penultimate week of the attachment.

Please read the following carefully.

Women’s Health - Observed Short Case - 20 minutes only

Guidance for the examiner

1. The patient must be selected by the examiner before the start of the assessment and have had no previous contact with, or knowledge of, the candidate.

2. The complexity of the case must be taken into account when forming a judgement about the students’ competence.3. At no point should the examiner interact with the candidate or patient during the assessment unless the examiner has

any concerns about the welfare of either the patient or the student.4. Questions to the student should relate only to the case in question ie diagnosis, investigations, treatment,

management plan, as indicated by the module’s “Guidance for Examiners”. Please do not ask any additional questions of the student.

5. Although you may have observed the students’ performance during their attachment please avoid using any other previous interaction with them as evidence of satisfactory performance in this assessment.

6. Please ensure that you follow the instructions relating to the conduct of examiners. Thank you for your help with this matter.

Completing the attached form

1. Please adhere to guidance on the detail of the domains which is given on the reverse of the placement based assessment form.

2. All relevant domains must be graded in accordance with the scale and the level of expected attainment of a 3a student.

3. The final judgement is binary – please indicate either “pass” or “fail”.4. Students’ value feedback on their performance as it facilitates their continued educational development. Students

who perform satisfactorily may not have the same perception of their performance as you do and may require reassurance that their skills and knowledge are adequate. Praising good performance is also most helpful to students. Poor performance should not be criticised in a destructive or humiliating manner; rather the areas of weakness must be discussed and a method of improving subsequent performance agreed with the student.

5. Please sign the form and supply your details as indicated.6. The form must be returned promptly to the appropriate member of the administrative staff.

The Medical School.

Registration Number

Phase 3a Summative Clinical Assessment FormObserved SHORT Case 2Is this a second attempt? YES □ NO □ (tick as appropriate)

NB use black ink only

WOMEN’S HEALTH2016

Student Name Date

Brief case summary Focus of encounter

History □Examination □

ASSESSMENTGrade the following againstthe standard expected for a3a student

NAWell below the

standard expected of a

3a student

Below the standard

expected of a 3a student

Standard expected of a

3a student

Above the standard

expected of a 3a student

Well above the standard expected of a

3a student

History □ □ □ □ □ □Examination □ □ □ □ □ □Clinical Reasoning Skills □ □ □ □ □ □Professional Behaviour □ □ □ □ □ □

Global Rating Fail □ Pass □

FEEDBACKGood or excellent performance Areas requiring attention

Assessors detailsName(please print)

Grade

Signature Date

Email

Return form to Mrs G Burkinshaw, Reproduction and Developmental Medicine, Jessop Wing, Tree Root Walk, Sheffield

TheMedicalSchool

NotesHistoryMedical Interviewing and Communication Skills. Facilitates patient’s telling of history & volunteering of information; effectively uses open and closed questions to obtain accurate, adequate information; responds appropriately to affect and non-verbal cues.ExaminationFollows efficient, logical sequence with appropriate questioning to elicit phenomenology; balances screening/diagnostic questions for the problem; conducts the examination sensitivelyDecision Making SkillsDemonstrates good judgement, synthesis and sifting of information in a focused way; is efficient and safe; knows limitations of personal competence and knows when to request help; is able to formulate a differential diagnosis, discuss appropriate investigations, and plans for immediate management, including risks and benefits.Professional BehaviourIntroduces self appropriately, washes hands, shows respect, compassion, empathy, establishes trust; attends to patient’s needs and respects patient confidentiality, chooses an appropriate environment for the interview, is aware of and sensitive to the patient's cultural background.

Phase 3a 2016Placement Based Assessment

This is an observed examination and examination regulations apply.

The assessment should take place during the penultimate week of the attachment.

Please read the following carefully.

Community and Public Health - Observed Short Case - 20 minutes only

Guidance for the examiner

1. The patient must be selected by the examiner before the start of the assessment and have had no previous contact with, or knowledge of, the candidate.

2. The complexity of the case must be taken into account when forming a judgement about the students’ competence.3. At no point should the examiner interact with the candidate or patient during the assessment unless the examiner has

any concerns about the welfare of either the patient or the student.4. Questions to the student should relate only to the case in question ie diagnosis, investigations, treatment,

management plan, as indicated by the module’s “Guidance for Examiners”. Please do not ask any additional questions of the student.

5. Although you may have observed the students’ performance during their attachment please avoid using any other previous interaction with them as evidence of satisfactory performance in this assessment.

6. Please ensure that you follow the instructions relating to the conduct of examiners. Thank you for your help with this matter.

Completing the attached form

1. Please adhere to guidance on the detail of the domains which is given on the reverse of the placement based assessment form.

2. All relevant domains must be graded in accordance with the scale and the level of expected attainment of a 3a student.

3. The final judgement is binary – please indicate either “pass” or “fail”.4. Students’ value feedback on their performance as it facilitates their continued educational development. Students

who perform satisfactorily may not have the same perception of their performance as you do and may require reassurance that their skills and knowledge are adequate. Praising good performance is also most helpful to students. Poor performance should not be criticised in a destructive or humiliating manner; rather the areas of weakness must be discussed and a method of improving subsequent performance agreed with the student.

5. Please sign the form and supply your details as indicated.6. The form must be returned promptly to the appropriate member of the administrative staff.

The Medical School.

Registration Number

Phase 3a Summative Clinical Assessment FormObserved SHORT Case 1Is this a second attempt? YES □ NO □ (tick as appropriate)

NB use black ink only

COMMUNITY &PUBLIC HEALTH2016

Student Name Date

Brief case summary Focus of encounter

History □Examination □

ASSESSMENTGrade the following againstthe standard expected for a3a student

NAWell below the

standard expected of a

3a student

Below the standard

expected of a 3a student

Standard expected of a

3a student

Above the standard

expected of a 3a student

Well above the standard expected of a

3a student

History □ □ □ □ □ □Examination □ □ □ □ □ □Clinical Reasoning Skills □ □ □ □ □ □Professional Behaviour □ □ □ □ □ □

Global Rating Fail □ Pass □

FEEDBACKGood or excellent performance Areas requiring attention

Assessors detailsName(please print)

Grade

Signature Date

Email

Return form to Peggy Haughton/ Laura Besson Academic Unit of Primary Medical Care, Sam Fox House, NGH

TheMedicalSchool

NotesHistoryMedical Interviewing and Communication Skills. Facilitates patient’s telling of history & volunteering of information; effectively uses open and closed questions to obtain accurate, adequate information; responds appropriately to affect and non-verbal cues.ExaminationFollows efficient, logical sequence with appropriate questioning to elicit phenomenology; balances screening/diagnostic questions for the problem; conducts the examination sensitivelyDecision Making SkillsDemonstrates good judgement, synthesis and sifting of information in a focused way; is efficient and safe; knows limitations of personal competence and knows when to request help; is able to formulate a differential diagnosis, discuss appropriate investigations, and plans for immediate management, including risks and benefits.Professional BehaviourIntroduces self appropriately, washes hands, shows respect, compassion, empathy, establishes trust; attends to patient’s needs and respects patient confidentiality, chooses an appropriate environment for the interview, is aware of and sensitive to the patient's cultural background.

Phase 3a 2016Placement Based Assessment

This is an observed examination and examination regulations apply.

The assessment should take place during the penultimate week of the attachment.

Please read the following carefully.

Community and Public Health - Observed Short Case - 20 minutes only

Guidance for the examiner

1. The patient must be selected by the examiner before the start of the assessment and have had no previous contact with, or knowledge of, the candidate.

2. The complexity of the case must be taken into account when forming a judgement about the students’ competence.3. At no point should the examiner interact with the candidate or patient during the assessment unless the examiner has

any concerns about the welfare of either the patient or the student.4. Questions to the student should relate only to the case in question ie diagnosis, investigations, treatment,

management plan, as indicated by the module’s “Guidance for Examiners”. Please do not ask any additional questions of the student.

5. Although you may have observed the students’ performance during their attachment please avoid using any other previous interaction with them as evidence of satisfactory performance in this assessment.

6. Please ensure that you follow the instructions relating to the conduct of examiners. Thank you for your help with this matter.

Completing the attached form

1. Please adhere to guidance on the detail of the domains which is given on the reverse of the placement based assessment form.

2. All relevant domains must be graded in accordance with the scale and the level of expected attainment of a 3a student.

3. The final judgement is binary – please indicate either “pass” or “fail”.4. Students’ value feedback on their performance as it facilitates their continued educational development. Students

who perform satisfactorily may not have the same perception of their performance as you do and may require reassurance that their skills and knowledge are adequate. Praising good performance is also most helpful to students. Poor performance should not be criticised in a destructive or humiliating manner; rather the areas of weakness must be discussed and a method of improving subsequent performance agreed with the student.

5. Please sign the form and supply your details as indicated.6. The form must be returned promptly to the appropriate member of the administrative staff.

The Medical School.

Registration Number

Phase 3a Summative Clinical Assessment FormObserved SHORT Case 2Is this a second attempt? YES □ NO □ (tick as appropriate)

NB use black ink only

COMMUNITY &PUBLIC HEALTH2016

Student Name Date

Brief case summary Focus of encounter

History □Examination □

ASSESSMENTGrade the following againstthe standard expected for a3a student

NAWell below the

standard expected of a

3a student

Below the standard

expected of a 3a student

Standard expected of a

3a student

Above the standard

expected of a 3a student

Well above the standard expected of a

3a student

History □ □ □ □ □ □Examination □ □ □ □ □ □Clinical Reasoning Skills □ □ □ □ □ □Professional Behaviour □ □ □ □ □ □

Global Rating Fail □ Pass □

FEEDBACKGood or excellent performance Areas requiring attention

Assessors detailsName(please print)

Grade

Signature Date

Email

Return form to: Peggy Haughton/ Laura Besson, Sam Fox House, NGH

TheMedicalSchool

NotesHistoryMedical Interviewing and Communication Skills. Facilitates patient’s telling of history & volunteering of information; effectively uses open and closed questions to obtain accurate, adequate information; responds appropriately to affect and non-verbal cues.ExaminationFollows efficient, logical sequence with appropriate questioning to elicit phenomenology; balances screening/diagnostic questions for the problem; conducts the examination sensitivelyDecision Making SkillsDemonstrates good judgement, synthesis and sifting of information in a focused way; is efficient and safe; knows limitations of personal competence and knows when to request help; is able to formulate a differential diagnosis, discuss appropriate investigations, and plans for immediate management, including risks and benefits.Professional BehaviourIntroduces self appropriately, washes hands, shows respect, compassion, empathy, establishes trust; attends to patient’s needs and respects patient confidentiality, chooses an appropriate environment for the interview, is aware of and sensitive to the patient's cultural background.