Surgery Evaluation Standards
















Clerkship Student Formative Evaluation


RFUMS/The Chicago Medical School


Surgery Clerkship

Rotation Dates:


From:               To:


Circle the box which best describes your typical performance for appropriate meeting of curricular objectives and clinical competencies in each of the following categories.


The following are examples of behaviors/performance that guide you in assessing your performance. The list of examples is not comprehensive and only provides guidance.


I.  Medical and Scientific


Demonstrates knowledge about established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences and applies this knowledge in caring for patients.


Does Not Meet Standards

Partially Meets Standards

Meets Standards

Exceeds Standards



Fund of knowledge of normal and altered structure and function and diagnostic methods is below that expected for a third year surgical student


Fund of knowledge adequate to address common presentations of surgical conditions


Good fund of surgical knowledge


Fund of knowledge includes information on less common core surgical conditions






II.  Patient Care and


Demonstrates patient centered care that is compassionate, appropriate, and effective for the promotion of health, quality of life, prevention of illness, treatment of disease, and the end of life.


Does Not Meet


Partially Meets Standards

Meets Standards

Exceeds Standards




Often unable to complete history due to insufficient or inaccurate information






Does not consistently demonstrate proper technique when performing the physical examination




Difficulty interpreting common diagnostic procedures and developing a differential diagnosis and treatment plan





Unable to demonstrate the ability to use preventive strategies in patient care




Unable to recognize life- threatening conditions or institute appropriate initial therapy



Able to perform complete histories on uncomplicated cases


Complicated cases at times disorganized




Consistently uses proper technique when performing the physical examination






Able to interpret basic diagnostic procedure and develop a differential diagnosis and treatment plan for common surgical problems






Able to use preventive strategies for common diseases






Able to recognize common life- threatening conditions and institute appropriate initial therapy



Consistently obtains complete histories, only missing less critical information






Consistently uses proper technique and identifies major abnormalities and pertinent normal findings



Consistently complete, well organized histories





Consistently performs a comprehensive physical examination using proper technique and appropriately focuses exams as needed




Able to interpret complex diagnostic procedures andevelop differential diagnosis and treatment plans for common and  at times less common surgical problems





Able to use preventive strategies for a wide variety of diseases






Able to recognize common and uncommon life-threatening conditions and institute appropriate initial therapy






III.  Professionalism and Self- awareness

Demonstrates a commitment to professional service, adherence to ethical principles, sensitivity to diverse populations, and awareness of one’s own interests and vulnerabilities.


Does Not Meet


Partially Meets Standards

Meets Standards

Exceeds Standards



Has some difficulty recognizing limitations, tendency towards arrogance


Disrespectful to any member of healthcare team and/or patients




Sometimes has difficulty accepting constructive feedback


Recognizes limitations in knowledge/skill and asks for help



Never disrespectful toward patient or team members





Accepts feedback well but may not actively seek it


Good ability at self assessment




Makes an active effort to treat everyone with respect and courtesy




Actively seeks feedback


Very good ability to identify strengths and weaknesses




Professional demeanor(respect, courtesy, honesty, integrity) is very good


Actively seeks feed- back and adjusting behaviors accordingly








IV.  Practice-based, Life-long


Demonstrates the ability to appraise and assimilate scientific evidence and methods to investigate, evaluate and improve one’s own patient care practices.


Does Not Meet Standards

Partially Meets Standards

Meets Standards

Exceeds Standards


Reading is inconsistent or too




Slow to learn from mistakes, tends to repeat them

Reads about patients’ problems

and tries to apply what is learned


Learns from mistakes but sometimes has trouble recognizing errors

Consistently reads and applies

it to patient care



Recognizes errors and rarely repeats mistakes

Reads extensively and often from

the most current sources



Actively seeks to anticipate
    potential errors and tries to
    prevent them






V. Systems-based, Inter

Professional Practice

Demonstrates an awareness of and responsiveness to the larger context of health care and the ability to call on system resources and other health care

professionals to provide optimal care.


Does Not Meet Standards



Meets Standards


Insufficiently aware of the

roles of the members of the health care team




Insufficiently aware of how cost, insurance, and resource allocation practically affect patient care



Appreciates the different roles
of all members of the health care team and applies this to patient care



Understands general costs of care and commujnity resources







VI.  Interpersonal and

Communication Skills

Demonstrates effective understanding, information exchange, and teamwork with patients, their families, and other health professionals.


Does Not Meet


Partially Meets Standards

Meets Standards

Exceeds Standards




Does not demonstrate at all times the ability to be respectful in relationships with patients, their

families, and colleagues



Notes sometimes illegible, incomplete, and/or contain inaccurate data










Notes legible, accurate and miss only minor details










Notes usually can stand on their own with little need for addendums



Students must always demonstrate the ability to sustain therapeutic, ethically sound, respectful professional relationships with patients, their families, and colleagues


Notes complete and organized




Life in Discovery