1. Mini-Clinical Evaluation Exercise

Abington Memorial Hospital Department of Medicine
Internal Medicine Residency Program

When this form is completed, please print it and submit it to the Department of Medicine, 2nd floor Elkins Bldg
Phone: (215) 481-2024
Fax: (215) 418-4361

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* 1. Name of Evaluator

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* 2. Name of Resident

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* 3. Resident Training Level

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* 4. Date encounter occurred

Date

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* 5. Setting and if inpatient, please enter the team below

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* 6. Please enter the patient's age and gender

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* 7. Complexity of encounter:

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* 8. Focus of the encounter

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* 9. Medical Interviewing Skills: Facilitates patient's telling of story; effectively uses questions and directions to obtain accurate, adequate information needed; responds appropriately to affect, non-verbal cues

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* 10. Physical Examination Skills: Follows an efficient, logical sequence; appropriately selective balance of screening/diagnostic steps for problem; alerts patient of next moves, attends to patient's comfort, modesty

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* 11. Counseling Skills: Explains rationale for test and treatment, obtains patient's consent, educates/counsels regarding management

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* 12. Clinical Judgement: Selectively orders or performs diagnostic studies appropriate to patient's perspective with medical facts, costs, risks, benefits; informs patient of appropriate diagnostic possibilities

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* 13. Humanistic Qualities and Professionalism: Demonstrates respect, compassion, empathy, establishes trust; attends to patient needs for comfort, modesty, confidentiality, information, encouragement

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* 14. Overall Clinical Competence: Safe, Timely Efficient, Effective, Equitable, Patient Centered; Judgement, synthesis, caring, analysis

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* 15. Please add comments (what resident did well, what resident failed to do)

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* 16. Please delineate an ACTION PLAN for follow up/improvement

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* 17. Was this CEX discussed with the resident?

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