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To the Patient
If you encounter a not significant in the patient notes, please add something from your own personal life. You can use friends, family members and celebrities as a guide, if youd like. The key to this examination is for the doctor to be prepared for any and all types of patient, from the easy-going patient to the somewhat more difficult one. We thank you for helping this doctor in this exam getting a real patient is key to learning to deal and cope with all that comes his/her way. Any and all constructive criticism for the doctor is appreciated, as it does count! Actors from all walks of life take part in this examination, many of which are just like you. Unsatisfactory = 1 Marginally Satisfactory = 2 Good = 3 Excellent = 4

History taking skills:

Ability to ask appropriate questions Detailed questions about symptom Questions about past medical history Questions about medication and allergy Questions about family history Questions about social history Review of systems 1 1 1 1 1 1 1 2 2 2 2 2 2 2 3 3 3 3 3 3 3 4 4 4 4 4 4 4

Examination
Body language Confidence Attitude Empathy Permission for examination Confidence in examination Courteous during exam Examined appropriate system Y N 1 1 1 1 2 2 2 2 3 3 3 3 Y 3 3 3 4 4 4 4 N 4 4 4

Draping: 1 1 1 2 2 2

Interpersonal skills
Giving information Counseling English Comprehension Support/Empathy 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4

Overall Impression

Is there something you would like to see in the doctor that he/she did not do?

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Patient Rating Sheet

This is what the doctor should be asking you and doing during the encounter. Please check off what he/she accomplished. Then read the patient note once the doctor is finished, and rate it for comprehension, legibility and neatness!

General Guidelines (____ out of 22 checked) o Doctor introduces himself by name o Doctor identifies his/her role or position o Doctor uses patients name o Doctor asks about onset o Doctor asks about details/intensity o Doctor asks about frequency o Doctor asks about alleviating factors o Doctor asks about associated symptoms o Doctor asks about genitourinary problems o Doctor asks about diarrhea, constipation, blood in stools. o Doctor asks about progression ___ o Doctor asks about aggravating factors __ o Doctor asks about medications o Doctor asks about sleep patterns o Doctor asks about past illnesses o Doctor asks about hospitalizations o Doctor asks about childhood illnesses o Doctor asks about pregnancy (for females) o Doctor asks about menstrual history (for females) o Doctor asks about family history o Doctor asks about alcohol and tobacco o Doctor asks about recreational drugs

Physical Exam Checklist (____ out of 7 checked) o Doctor washed hands o Doctor palpated area in question o Doctor asked for permission for examination o Doctor draped patient o Doctor displayed confidence in examination o Doctor was courteous during examination o Doctor examined appropriate system Interpersonal Skills (___ out of 11 checked) o Doctor explained illness to patient o Doctor counseled patient o Doctor explained treatment plan o Doctor asked if treatment plan was agreeable to the patient o Doctor showed English comprehension o Doctor spoke slowly and clearly o Doctor seemed genuine o Doctor smiled occasionally o Doctor showed good body language o Doctor displayed confidence o Doctor showed support/empathy

_____ out of 40 checked = _______ %

Overall impression: In the future, would you like this candidate to be your personal physician, and why?