Henry Ford Health System Department of Family Practice Universal Clinical Skills Evaluation
Resident: Rotation: Evaluator: Date:
		Unacceptable, Intervention Required	Below expectations for grade level	Appropriately progressing towards competency for grade level	Competent for grade level	Exceeds expectations for grade level	Not Observed/ not applicable
Medical Knowledge
1.	Demonstrates extensive, well integrated fund of medical knowledge.
2.	Demonstrates extensive, well-integrated fund of psychiatric/psychosocial knowledge.
3.	Demonstrates an investigatory and analytic approach to clinical situations.
4.	Demonstrates knowledge and skills of osteopathic principles.
5.	Selects appropriate diagnostic tests.
Practice-Based Learning and Improvement
6.	Integrates evidence-based data in formulation of diagnosis and treatment plan.
7.	Recognizes and remediates knowledge deficits.
8.	Uses time efficiently. Well-organized.
Patient Care
9.	Elicits a precise, logical, thorough medical history.
10.	Elicits an appropriate, complete psychiatric/psychosocial history.
11.	Conducts an appropriate and accurate physical examination.
12.	Presents cases in an accurate, concise, logically sequenced manner.
13.	Develops treatment plans individualized to the patient.
14.	Integrates psychosocial factors in formulation of diagnosis and treatment.
15.	Delivers health care directed toward disease prevention and maintenance of health.
16.	Medical record documentation is timely, complete, and concise.

Patient Care cont.		Unacceptable, Intervention Required	Unacceptable, Intervention Required	Appropriately progressing towards competency for grade level	Competent for grade level	Exceeds expectations for grade level	Not Observed/ not aplicable
17.	Provides timely follow-up of abnormal laboratory/imaging/pathology results.
18.	Performs procedures in a proficient manner with minimal risk/discomfort to the patient.
19.	Monitors patients’ clinical status appropriately.
Systems-Based Practice
20	Utilizes system resources appropriately and assists patients in their use.
21.	Utilizes community resources appropriately and assists patients in their use.
Professionalism
22.	Attends sessions as scheduled.
23.	Is punctual.
24.	Demonstrates integrity, empathy, compassion, and respect for patients and families, with primary concern for the patient’s welfare.
25.	Demonstrates sensitivity and responsiveness to patients’ culture, age, gender, disabilities.
26.	Appropriately considers ethical issues.
27.	Is responsive, respectful, and cooperative with all members of the health care team
Interpersonal and Communication Skills
28.	Communicates effectively and develops good rapport with patient and family.
29.	Communicates effectively and develops good rapport with team members.
30.	Utilizes effective communication skills to educate patients and promote optimal health behaviors.
31.	Appropriately includes patients in their own care and negotiates treatment decisions.