Gersten Jonker

The ACTY: acute care transitional year   41 2 TABLE 4: Example of a short clinical observation form to link workplace assessment with ACTY EPAs DTY ‘acute care’, UMC Utrecht, version February 2016 DEDICATED TRANSITIONAL YEAR ‘ACUTE CARE’ SHORT CLINICAL OBSERVATION FORM ONLY TO BE FILLED OUT AFTER DIRECT OBSERVATION, ASSESS AT LEVEL OF JUNIOR PHYSICIAN HISTORY OF A DYSPNEIC PATIENT Student: SETTING OF OBSERVATION ICU / CCU / Emergency Room / OR / Ward / Outpatient clinic New / Follow-up Short description of situation: Student number: Assessor: Assessor’s professional level: Hospital/department: Date of observation: Patient initials: M/F Age: Not (yet) meeting expectations Meeting expectations of junior physician Exceeding expectations Not assessed / not applicable FEEDBACK 1. Builds effective doctor- patient interaction 0 0 0 0 Specific observations of positive aspects: 1. 2. Specific observations of aspects needing improvement: 1. 2. TAKE HOME MESSAGE (to be filled out by student) 2. Asks sufficient and adequate questions 0 0 0 0 3. Asks questions to test hypotheses (differential diagnoses) 0 0 0 0 4. Discerns limitations, discusses doubts and consults timely 0 0 0 0 5. Interprets information gathered 0 0 0 0 Required supervision or intervention for this student in this particular activity Much Little Negligible None Signature assessor: Signature student: