Medical Student Evaluation Form
Doctor Name
First Name
Last Name
Hospital Name
Date
-
Month
-
Day
Year
Date
Student Name
First Name
Last Name
Evaluation
Poor
Average
Good
Excellent
Reporting
1
2
3
4
Physical Exam
5
6
7
8
Presentation
9
10
11
12
Problem Solving
13
14
15
16
Communication with Patients
17
18
19
20
Differential Diagnosis (DDx) &
Clinical Reasoning
21
22
23
24
Managing & Patient
Care
25
26
27
28
Humanistic Approach to Patient
29
30
31
32
Communication with Staff
33
34
35
36
Overall Evaluation
1
2
3
4
5
Overall Comments/Suggestions
Doctor's Signature
Submit
Should be Empty: