DIRECT OBSERVATION CARD

Name: ______________________________________ Evaluator: _______________________________

DIRECT OBSERVATION PHYSICAL EXAM – one must be observed by a faculty member.
Physical Exam: (3 required) Failing Marginal Acceptable Good Superior
Abdominal
Vascular
Neck
Breast
Wound
DIRECT OBSERVATION HISTORY TAKING – each HISTORY must be observed by one faculty.
Patient Education: Failing Marginal Acceptable Good Superior
Pre-op History (1 required)
Post-op History (1 required)
Technical Skills (suture, tying, etc.)
Oral Presentations

CRITIQUE OF HISTORY, PHYSICAL EXAM, SKILLS, INFORMATION

*Areas of Improvement: MANDATORY (The card is incomplete if this portion is not completed)
_____________________________________________________________________________________
_____________________________________________________________________________________

DIRECT OBSERVATION CARD

Name: ______________________________________ Evaluator: _______________________________

DIRECT OBSERVATION PHYSICAL EXAM – one must be observed by a faculty member.
Physical Exam: (3 required) Failing Marginal Acceptable Good Superior
Abdominal
Vascular
Neck
Breast
Wound
DIRECT OBSERVATION HISTORY TAKING – each HISTORY must be observed by one faculty.
Patient Education: Failing Marginal Acceptable Good Superior
Pre-op History (1 required)
Post-op History (1 required)
Technical Skills (suture, tying, etc.)
Oral Presentations

CRITIQUE OF HISTORY, PHYSICAL EXAM, SKILLS, INFORMATION

*Areas of Improvement: MANDATORY (The card is incomplete if this portion is not completed)
_____________________________________________________________________________________
_____________________________________________________________________________________

DIRECT OBSERVATION CARD

Name: ______________________________________ Evaluator: _______________________________

DIRECT OBSERVATION PHYSICAL EXAM – one must be observed by a faculty member.
Physical Exam: (3 required) Failing Marginal Acceptable Good Superior
Abdominal
Vascular
Neck
Breast
Wound
DIRECT OBSERVATION HISTORY TAKING – each HISTORY must be observed by one faculty.
Patient Education: Failing Marginal Acceptable Good Superior
Pre-op History (1 required)
Post-op History (1 required)
Technical Skills (suture, tying, etc.)
Oral Presentations

CRITIQUE OF HISTORY, PHYSICAL EXAM, SKILLS, INFORMATION

*Areas of Improvement: MANDATORY (The card is incomplete if this portion is not completed)
_____________________________________________________________________________________
_____________________________________________________________________________________
 DIRECT OBSERVATION CARD

Name: ______________________________________ Evaluator: _______________________________

DIRECT OBSERVATION PHYSICAL EXAM – one must be observed by a faculty member.
Physical Exam: (3 required) Failing Marginal Acceptable Good Superior
Abdominal
Vascular
Neck
Breast
Wound
DIRECT OBSERVATION HISTORY TAKING – each HISTORY must be observed by one faculty.
Patient Education: Failing Marginal Acceptable Good Superior
Pre-op History (1 required)
Post-op History (1 required)
Technical Skills (suture, tying, etc.)
Oral Presentations

CRITIQUE OF HISTORY, PHYSICAL EXAM, SKILLS, INFORMATION

*Areas of Improvement: MANDATORY (The card is incomplete if this portion is not completed)
_____________________________________________________________________________________
_____________________________________________________________________________________

DIRECT OBSERVATION CARD

Name: ______________________________________ Evaluator: _______________________________

DIRECT OBSERVATION PHYSICAL EXAM – one must be observed by a faculty member.
Physical Exam: (3 required) Failing Marginal Acceptable Good Superior
Abdominal
Vascular
Neck
Breast
Wound
DIRECT OBSERVATION HISTORY TAKING – each HISTORY must be observed by one faculty.
Patient Education: Failing Marginal Acceptable Good Superior
Pre-op History (1 required)
Post-op History (1 required)
Technical Skills (suture, tying, etc.)
Oral Presentations

CRITIQUE OF HISTORY, PHYSICAL EXAM, SKILLS, INFORMATION

*Areas of Improvement: MANDATORY (The card is incomplete if this portion is not completed)
_____________________________________________________________________________________
_____________________________________________________________________________________

DIRECT OBSERVATION CARD

Name: ______________________________________ Evaluator: _______________________________

DIRECT OBSERVATION PHYSICAL EXAM – one must be observed by a faculty member.
Physical Exam: (3 required) Failing Marginal Acceptable Good Superior
Abdominal
Vascular
Neck
Breast
Wound
DIRECT OBSERVATION HISTORY TAKING – each HISTORY must be observed by one faculty.
Patient Education: Failing Marginal Acceptable Good Superior
Pre-op History (1 required)
Post-op History (1 required)
Technical Skills (suture, tying, etc.)
Oral Presentations

CRITIQUE OF HISTORY, PHYSICAL EXAM, SKILLS, INFORMATION

*Areas of Improvement: MANDATORY (The card is incomplete if this portion is not completed)
_____________________________________________________________________________________
_____________________________________________________________________________________
 DIRECT OBSERVATION CARD

Name: ______________________________________ Evaluator: _______________________________

DIRECT OBSERVATION PHYSICAL EXAM – one must be observed by a faculty member.
Physical Exam: (3 required) Failing Marginal Acceptable Good Superior
Abdominal
Vascular
Neck
Breast
Wound
DIRECT OBSERVATION HISTORY TAKING – each HISTORY must be observed by one faculty.
Patient Education: Failing Marginal Acceptable Good Superior
Pre-op History (1 required)
Post-op History (1 required)
Technical Skills (suture, tying, etc.)
Oral Presentations

CRITIQUE OF HISTORY, PHYSICAL EXAM, SKILLS, INFORMATION

*Areas of Improvement: MANDATORY (The card is incomplete if this portion is not completed)
_____________________________________________________________________________________
_____________________________________________________________________________________

DIRECT OBSERVATION CARD

Name: ______________________________________ Evaluator: _______________________________

DIRECT OBSERVATION PHYSICAL EXAM – one must be observed by a faculty member.
Physical Exam: (3 required) Failing Marginal Acceptable Good Superior
Abdominal
Vascular
Neck
Breast
Wound
DIRECT OBSERVATION HISTORY TAKING – each HISTORY must be observed by one faculty.
Patient Education: Failing Marginal Acceptable Good Superior
Pre-op History (1 required)
Post-op History (1 required)
Technical Skills (suture, tying, etc.)
Oral Presentations

CRITIQUE OF HISTORY, PHYSICAL EXAM, SKILLS, INFORMATION

*Areas of Improvement: MANDATORY (The card is incomplete if this portion is not completed)
_____________________________________________________________________________________
_____________________________________________________________________________________

DIRECT OBSERVATION CARD

Name: ______________________________________ Evaluator: _______________________________

DIRECT OBSERVATION PHYSICAL EXAM – one must be observed by a faculty member.
Physical Exam: (3 required) Failing Marginal Acceptable Good Superior
Abdominal
Vascular
Neck
Breast
Wound
DIRECT OBSERVATION HISTORY TAKING – each HISTORY must be observed by one faculty.
Patient Education: Failing Marginal Acceptable Good Superior
Pre-op History (1 required)
Post-op History (1 required)
Technical Skills (suture, tying, etc.)
Oral Presentations

CRITIQUE OF HISTORY, PHYSICAL EXAM, SKILLS, INFORMATION

*Areas of Improvement: MANDATORY (The card is incomplete if this portion is not completed)
_____________________________________________________________________________________
_____________________________________________________________________________________
 DIRECT OBSERVATION CARD

Name: ______________________________________ Evaluator: _______________________________

DIRECT OBSERVATION PHYSICAL EXAM – one must be observed by a faculty member.
Physical Exam: (3 required) Failing Marginal Acceptable Good Superior
Abdominal
Vascular
Neck
Breast
Wound
DIRECT OBSERVATION HISTORY TAKING – each HISTORY must be observed by one faculty.
Patient Education: Failing Marginal Acceptable Good Superior
Pre-op History (1 required)
Post-op History (1 required)
Technical Skills (suture, tying, etc.)
Oral Presentations

CRITIQUE OF HISTORY, PHYSICAL EXAM, SKILLS, INFORMATION

*Areas of Improvement: MANDATORY (The card is incomplete if this portion is not completed)
_____________________________________________________________________________________
_____________________________________________________________________________________

DIRECT OBSERVATION CARD

Name: ______________________________________ Evaluator: _______________________________

DIRECT OBSERVATION PHYSICAL EXAM – one must be observed by a faculty member.
Physical Exam: (3 required) Failing Marginal Acceptable Good Superior
Abdominal
Vascular
Neck
Breast
Wound
DIRECT OBSERVATION HISTORY TAKING – each HISTORY must be observed by one faculty.
Patient Education: Failing Marginal Acceptable Good Superior
Pre-op History (1 required)
Post-op History (1 required)
Technical Skills (suture, tying, etc.)
Oral Presentations

CRITIQUE OF HISTORY, PHYSICAL EXAM, SKILLS, INFORMATION

*Areas of Improvement: MANDATORY (The card is incomplete if this portion is not completed)
_____________________________________________________________________________________
_____________________________________________________________________________________

DIRECT OBSERVATION CARD

Name: ______________________________________ Evaluator: _______________________________

DIRECT OBSERVATION PHYSICAL EXAM – one must be observed by a faculty member.
Physical Exam: (3 required) Failing Marginal Acceptable Good Superior
Abdominal
Vascular
Neck
Breast
Wound
DIRECT OBSERVATION HISTORY TAKING – each HISTORY must be observed by one faculty.
Patient Education: Failing Marginal Acceptable Good Superior
Pre-op History (1 required)
Post-op History (1 required)
Technical Skills (suture, tying, etc.)
Oral Presentations

CRITIQUE OF HISTORY, PHYSICAL EXAM, SKILLS, INFORMATION

*Areas of Improvement: MANDATORY (The card is incomplete if this portion is not completed)
_____________________________________________________________________________________
_____________________________________________________________________________________