1. Idaho State University
Physician Assistant
Evaluator: Jon Reyes - Preceptor Subject: John Scully - CY student
Activity: Internal Medicine - Poc Site: Washington State Department of
Correction
Evaluation Type: Preceptor Evaluation of Student -
Final
Completion
Date:
03/14/2016
Request Date: 03/09/2016
Period: R5: 2/15 - 3/18/2016 Dates of Activity: 02/15/2016 To 03/18/2016
Subject Participation
Dates:
02/15/2016 To 03/18/2016
Please make the appropriate selection under each heading:
ATTENDANCE AND PUNCTUALITY (Question 1 of 22 - Mandatory )
Not
Observed
Rarely
present/punctual
Often
absent/tardy
Sometimes
absent/tardy
Rarely
absent/tardy
Always
present/punctual
0 1 2 3 4 >> 5 <<
PROFESSIONAL APPEARANCE (Question 2 of 22 - Mandatory )
Not
Observed
Not
appropriate
for the
setting
Generally
appropriate;
unresponsive
to
suggestions
Generally
appropriately,
with a few
obvious
exceptions;
responds to
suggestions
Usually
appropriately,
with a few
minor
exceptions
Always
appropriate
0 1 2 3 4 >> 5 <<
INITIATIVE (Question 3 of 22 - Mandatory )
Not
Observed
Not well
motivated;
avoids
doing
whenever
possible
Just
getting
by;
accepts
requests
but often
fails to
follow
through
Accepts
requests,
generally
follows
through &
some-times
volunteers
Accepts
requests;
always
follows
through &
frequently
volunteers
Exceptional
motivation;
exceeds
expectations
0 1 2 3 4 >> 5 <<
CHARTS (Question 4 of 22 - Mandatory )
Not
Observed
Disorganized;
inaccurate;
material
irrelevant
Incomplete,
poorly
organized;
reflects less
than
adequate
understanding
of patients’
problems
Generally
accurate,
complete
& well
organized;
requires
minor
refinement
& clarity
Accurate,
complete &
well
organized;
reflecting
good
understanding
of patients’
problems
Concise,
relevant &
well
organized;
includes
subtleties
reflecting a
clear
understanding
of the case
0 1 2 3 4 >> 5 <<
KNOWLEDGE (Question 5 of 22 - Mandatory )

2. Not
Observed
Unable to
discuss
common
pathological
processes
with
accuracy
Fair
knowledge
of diseases;
has many
gaps in
fundamental
concepts
Discusses
pathophysiology
for most
common
diseases;
limitations in
breadth of
knowledge
Can
accurately
discuss
most
common
diseases;
knowledge
extends to
include a
few
uncommon
disease
entities
Extensive
knowledge of
pathophysiology
common
diseases and
other less
common
disease states
0 1 2 3 4 >> 5 <<
CLINICAL JUDGMENT (Question 6 of 22 - Mandatory )
Not
Observed
Decisions and
recommendations
often wrong &
ineffective
Sound
judgment
in less
than half
the
cases;
doesn’t
seem to
learn
from
mistakes
Errs
often
but
usually
learns
from
mistakes
Usually
shows
good
judgment
resulting
from
sound
evaluation
of factors
Sound
logical
thinker;
considers
all factors
to reach
accurate
decisions;
contributes
in complex
cases
0 1 2 3 4 >> 5 <<
CLINICAL MANAGEMENT (Question 7 of 22 - Mandatory )
Not
Observed
Contributes
little to
patient
management
plan
Suggests
only
routine
care
most of
the time;
usually
fails to
follow the
patient
closely
Sound
ideas, but
needs
general
assistance
with clinical
management
Good
judgment;
less than
extensive
knowledge
base in
clinical
management
Sound
judgment &
extensive
know-ledge in
clinical
management;
seldom
requires
assistance
0 1 2 3 4 >> 5 <<
TEAM PARTICIPATION (Question 8 of 22 - Mandatory )
Not
Observed
Behavior
undermines
team effort
Very often
insensitive
to others
Often
sensitive
to
others;
minor
problems
with
team
members
Almost
always
sensitive
to others
Always
considerate
others;
promotes
relations
among
team
members
0 1 2 3 4 >> 5 <<
PROFESSIONAL RELATIONSHIPS (Question 9 of 22 - Mandatory )
Not
Observed
Behavior is
unacceptable;
does not
cooperate;
makes poor
impression
Behavior is
usually
acceptable;
cooperates
when
necessary;
makes little
impression
Maintains
acceptable
& workable
relationships
Establishes
atmosphere
of mutual
respect &
dignity with
others
Commands
admiration
& respect
of others;
conducts
him/herself
as a true
professional
0 1 2 3 4 >> 5 <<
RELATIONSHIP WITH PATIENTS (Question 10 of 22 - Mandatory )

3. Not
Observed
Unable to
establish
appropriate
rapport
Fair rapport;
often a lack of
communication
Generally
good rapport;
occasional
difficulty
communicating
Good rapport;
listens &
communicates
his/her
concern for
the patients’
problems
Excellent
rapport
with even
the most
difficult
patients;
instills
confidence
in his/her
ability
0 1 2 3 4 >> 5 <<
HISTORY TAKING (Question 11 of 22 - Mandatory )
1
Not
Observed
Unable to
elicit an
accurate
history;
cannot elicit
the
pertinent
facts
surrounding
a patient’s
symptoms
Able to elicit
some pertinent
facts relating to
patient’s
symptoms; lacks
insight into
symptoms/course
of diseases
Generally
elicits an
accurate
history,
but some
problems
eliciting
all the
pertinent
facts
Good
history
taking
skills;
elicits an
accurate
history;
rarely
has a
problem
eliciting
all the
pertinent
facts
Excellent
history
taking
skills even
with the
most
complex
patients;
elicits all
pertinent
facts;
exceptional
insight into
symptoms
of diseases
0 1 2 3 4 >> 5 <<
PERFORMING PHYSICAL EXAMINATIONS (Question 12 of 22 - Mandatory )
Not
Observed
Does not
perform
pertinent or
PE
techniques;
findings are
not
reproducible;
unable to
recognize
signs of
disease
Performs
some
appropriate
PEs relating
to patient’s
symptoms;
lacks insight
into
signs/course
of diseases
Generally
performs an
accurate,
reproducible
PE,
occasional
problems
eliciting or
recognizing
all the
pertinent
physical
findings
Good PE
skills;
usually
performs an
accurate,
reproducible
PE; rarely
has a
problem
eliciting or
recognizing
all the
pertinent
findings
Excellent
PE skills
even with
the most
complex
patients;
elicits all
pertinent
findings;
exceptional
insight into
signs of
diseases
0 1 2 3 4 >> 5 <<
UTILIZING DIAGNOSTIC STUDIES (Question 13 of 22 - Mandatory )
Not
Observed
Lacks basic
understanding of
indications/
contraindications,
performance,
and
interpretation of
common
diagnostic studies
Appropriately
performs,
utilizes
and/or
interprets
some
diagnostic
studies
Appropriately
performs,
utilizes and
interprets
most
diagnostic
studies
Good
understanding of
indications,
contraindications/
performance,
and
interpretation of
most diagnostic
studies
Excellent
understanding of
indications,
contraindications,
performance,
and
interpretation of
most diagnostic
studies
0 1 2 3 4 >> 5 <<
FORMULATING DIFFERENTIAL DIAGNOSES (Question 14 of 22 - Mandatory )

4. Not
Observed
Lacks
ability to
form
appropriate
differential
diagnosis
Able to
form
partial
differential
diagnosis,
but
misses
some
essential
conditions
Able to
articulate
a
differential
diagnosis
with most
essential
conditions,
but not
quite
complete
Good
complete
differential
with all
essential
conditions
Excellent
complete
differential
diagnosis
with all
essential
conditions
and some
less
common
diseases;
exceptional
insight
0 1 2 3 4 >> 5 <<
EMERGENCY MEDICAL KNOWLEDGE, SKILLS, AND ABILITIES (Question 15 of 22 - Mandatory )
Not
Observed
Lacks the
knowledge,
skills, or
abilities to
respond
appropriately
to common
situations
encountered
Able to
respond to
some
common
conditions,
but
knowledge,
skills, or
abilities are
weak
In general,
responds
appropriately
to at least
50% of
emergent
conditions
encountered
Good level
of
knowledge,
skills, &
abilities;
responds
appropriately
to at least
75% of
common
conditions
encountered
Performs
above level
of
expectation;
exceptional
insights and
abilities;
responds
appropriately
to 90% of
common
conditions
0 1 2 3 4 >> 5 <<
PATIENT EDUCATION, HEALTH PROMOTION, AND DISEASE PREVENTION (PEHPDP) (Question 16 of 22
- Mandatory )
Not
Observed
Failed to
demonstrate
an
understanding
of basic
PEHPDP
knowledge,
skills, or
abilities
Able to
provide
some
PEHPDP
information;
knowledge,
skills, or
abilities are
weak
Usually
able to
provide
pertinent
and
appropriate
PEHPDP
information
to patients
Good
knowledge,
skills, and
abilities in
presenting
PEHPDP
information
in the most
cases
Excellent
knowledge,
skills, and
abilities in
presenting
PEHPDP
information;
exceptional
insights
0 1 2 3 4 >> 5 <<
EVIDENCE-BASED PRACTICE (EBM) (Question 17 of 22 - Mandatory )
Not
Observed
Failed to
demonstrate
any
understanding
or utilization of
evidence-based
medicine
(EBM); did not
seem to utilize
medical
literature
Demonstrates
some
understanding
and utilization
of EBM in
patient care;
rarely utilized
current
medical
literature
In general,
demonstrates
a fair
understanding
and utilization
of EBM in
patient care;
some
utilization of
current
literature
demonstrated
Good
understanding
and utilization
of EBM in
patient care;
demonstrated
the ability to
utilize current
literature
Excellent
understanding
and utilization
of EBM;
exceptional
ability to
utilize the
current
medical
literature;
exceptional
insight
0 1 2 3 4 >> 5 <<
CULTURAL COMPETENCY (Question 18 of 22 - Mandatory )
Insensitive
to the
various
cultural,
racial, or
Shows
some
sensitivity
to the
various
cultural,
racial, or
other
minority
patients
seen in this
practice;
In general
demonstrates
sensitivity to
the various
cultural,
racial, or
other minority
Good
demonstration
of sensitivity
Excellent
sensitivity
to the
various
cultural,
racial, or
other

5. Not
Observed
racial, or
other
minority
patients
seen in
this
practice
practice;
minimal
inflexibility
or
insensitivity
dealing
with others
other minority
patients seen
in this
practice; no
inflexibility or
insensitivity
noted
of sensitivity
to the various
cultural,
racial, or other
minority
patients seen
in this practice
other
minority
patients
seen in this
practice;
exceptional
insights
0 1 2 3 4 >> 5 <<
ETHICS (Question 19 of 22 - Mandatory )
Not
Observed
I have
grave
concerns
about
students’
ethics
Some
concerns
about
students’
ethics
No
concerns
about
students’
ethics
0 1 2 3 4 >> 5 <<
Overall Evaluation (Question 20 of 22 - Mandatory )
Considering all of the above factors, I feel the student's performance was satisfactory:
Strongly
Disagree Disagree Neutral Agree
Strongly
Agree
1 2 3 4
>> 5
<<
GENERAL COMMENTS (Question 21 of 22 )
Mr. Scully was a pleasure to have in our hospital. He showed an exceptional drive to learn and employed a very strong knowledge
base. We discussed multiple disease processes with a diverse and complex patient population; Mr. Skully showed proficiency in all
subjects. His written notes were some of the best that I have seen from prior students. His ability to work with our staff and manage
multiple patients at one time in our very busy in-patient unit was impressive. I am confident that Mr. Scully is well on his way to
becoming a great PA!
Was this evaluation discussed with the student? (Question 22 of 22 - Mandatory )
Selection Option
X Yes
No