STRUCTURED CLINICAL OBSERVATION – PCC
                                   Pediatrics Clerkship

Student:                                             Date:


Type of visit:           well visit   sick visit

Student: Give this form to a preceptor before going to see a patient; tell the preceptor
which room you will be in.

Preceptor: Indicate the portion of visit and particular items observes.

            Data Gathering               Physical Examination         Information Giving
     Interim History (well visits)    HEENT                     Anticipatory Guidance
     CC/HPI (sick visits)             Cardiac                   Immunization Consent
     Family History                   Pulmonary                 Instruction/explanation
     Social History                   Abdominal                 Other
     Developmental History            Genito-urinary
     School Performance               Orthopedic
     Diet History                     Neurological
     Sexual History

Specific Observations or Comments (with reference to Skill Guidelines on other side):

Key Feedback Points:



                             STRUCTURED CLINICAL OBSERVATION
                                      Skill Guidelines

         Date Gathering                     Physical Examination            Information Giving

Date collection                         Physical examination         Information giving
 Starts with open ended questions       Washes hands                Explains diagnosis
 Progresses with specific questions     Minimizes discomfort        Explains management plan
 Does not ask multiple questions        Preserves modesty           Uses visual & written
 Does not ask presumptive/leading       Explains exam to parent       reinforcement
  questions                              Explains exam to child      Appropriately includes child in
 Does not interrupt patient             Sequence of exam matches      explanation
 Asks for clarification if necessary     cooperation level           Avoids jargon/explains medical
 Appropriately includes child in        Builds rapport                terms used
  interview                              Correct technique           Solicits questions
 Logical sequencing of questions                                     Explains reasons for
 Segment summary                                                       recommendations
                                                                      Explains reasons for follow-up
Relationship skills
 Listens carefully (nods, "mm-hm")                                  Management
 Reflects patient's feelings or                                      Assesses understanding of
  concerns                                                             patient/family
 Legitimizes patients feelings or                                    Assesses patient's/family's
  concerns                                                             willingness to follow
 Offers partnership, support or                                       recommendations
  praise                                                              Assesses patient's/family's ability
                                                                       to follow recommendations
Personal manner                                                       Arranges for follow-up
 Appearance                                                          Explains when/why family should
 Good eye contact                                                     contact physician
 Appropriate, open body language
 Sits down                                                          Personal manner
 Appropriate facial expression                                       Appearance
 Appropriate tone of voice                                           Good eye contact
 Uses silence appropriately                                          Appropriate, open body language
                                                                      Sits down
Opening/closing the interview                                         Appropriate facial expression
 Introduces self                                                     Appropriate tone of voice
 Calls parent/chid by name                                           Uses silence appropriately
 Shakes hands entering
 Shakes hands leaving                                               Opening/closing the interview
                                                                      Introduces self
                                                                      Calls parent/child by name
                                                                      Shakes hands entering
                                                                      Shakes hands leaving

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