KUHS – Kerala University of Health Sciences – MD (Hom - Similima

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Model Evaluation form for Clinical Works in IPD/OPD
Name of the student Name of faculty/ Observer
Date:
(To be completed once in a month by respective unit heads including posting in other
departments if any)
Sl Items for observation Poor Below Average Average Good Very
No
Good
1 Regularity of attendance
2 Punctuality
3 Interaction with colleagues and staff
4 Maintenance of case record
5 Presentation of case during rounds
6 Investigations work up
7 Bedside manners
8 Rapport with patients
9 Counseling of patients and relatives
10 Overall quality of ward work
Total Score