Third Year Medical Student Observed History and Physical Examination - PDF - PDF by umsymums38


									Third Year Medical Student Observed History and Physical Examination

                                      Name: ___________________________

                                      Patient: __________________________
 Consent Obtained from
 Chief Complaint taken
                                            Pertinent Review of Systems
 History of Present Illness (taken
 in logical sequence with pertinent         Physical Examination
 positives and negatives asked)
                                                   Vital Signs
 Past Medical History                              HEENT
        Birth History                              Nodes
        Development                                Chest / Lungs
        Diet                                            Observation of
        Medical Illnesses                               respiratory rate
        Surgical                                        Observation of
        Illnesses/Procedures                            retractions
        Medications                                Cardiac
        Allergies                                       Palpation
        Immunizations                              Auscultation
 Family History                                    Abdomen
                                                        Bowel sounds
    Genetic Illnesses                                   Palpation
    Early Cardiac Deaths                                Liver edge and spleen
    Hypertension                                   GU
    Hypercholesterolemia                           Back / CVA tenderness
    Diabetes                                       (if applicable)
    Cancer (type?)                                 Extremities
    Pulmonary Conditions                                Hips (if infant)
    (asthma, CF, etc.)                             Skin
    Other (depending on                            Neurologic
                                            Wrap Up and Explanation to
 Social History                             Parent / Child

    People in home                          Wrap Up to Observer
    Smokers in home or
     Third Year Medical Student Observed History and Physical Examination

Observer's Formative Feedback to Student (not to be included on "white sheet").

Parent's Formative Feedback to Student (not be included on "white sheet").

Child's Formative Feedback (if appropriate).



Observer: __________________                   Student: _____________________
     Third Year Medical Student Observed History and Physical Examination

        As part of our third year medical student rotation, the national governing board of
medical schools requires that students perform a complete history and physical
examination on pediatric patient. Your child has been identified as a good candidate for
this process. However, participation is completely voluntary. The examination is to be
observed by a faculty member or upper level resident physician in pediatrics, and
feedback will be given to the medical student. In fact, if you choose to participate, your
feedback to the student will be very important as well. We would like for you to be
honest about how he/she approached you and your child during the examination and
about how you and your child felt during the questioning and examination process. This
is a great opportunity for you and your child to help influence the behavior of the next
generation of America's physicians.

        If you choose to allow this process please remember one important point. The
medical student will, as part of the process, be asked to summarize his or her findings and
diagnosis to you. He or she will not have had and opportunity to review your child's
chart before the examination, though he or she will discuss findings with the observing
physician before the summary is given. If you have any concerns about what the student
tells you, please discuss them with the physician in attendance after the interview is over.
This process should not increase your anxiety.

Thank you for considering participation in this important education process.


       I _________________________ give consent for ______________________ to
perform a history and physical examination on my child _________________________.
This consent is given freely. I understand that I may limit any part of the examination I
choose and may decide not to continue to participate at any time.

_______________________________               _______________________________
Parent or Guardian                            Physician Preceptor


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