clerkship handbook - University of Hawaii – Department of Medicine

U.H. John A. Burns School of Medicine
Third-Year Clerkship in Internal Medicine
OBSERVED PATIENT COUNSELING
Evaluation Form
Complete 2 during ambulatory medicine and turn in to your Ambulatory Preceptor.
Student: __________________________ Site: ________________ Date: __________
Setting: _____ Inpatient
Counseling was directed at: _____ Patient
_____ Ambulatory (check one or both) _____ Patient’s family
Counseling:
___ Explain diagnoses
___ Explain tests, procedures or surgery
___ Review results of tests, procedures or surgery
___ Review medications (indications, dosing, side effects, etc.)
___ Review diets, exercise or other lifestyle changes
___ Discuss smoking cessation
___ Discuss alcohol use
___ Discuss compliance (medications, follow-up, etc.)
___ Review discharge instructions
___ Other (specify) ___________________________
Good
Needs Improvement
Student used clear and understandable language.
Student adapted to patient’s/family’s readiness to learn.
Student adapted to patient’s/family’s comprehension level
All pertinent information was presented accurately.
Student demonstrated empathy and compassion.
Patient’s/family’s comprehension was assessed.
Evaluator Comments:
Evaluator’s name _________________________
Evaluator’s signature _______________________
Student’s signature _______________________
I received constructive feedback on my Observed Patient Counseling (circle): Yes No
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