Clinical Case Presentation Evaluation Form
Evaluate a clinical case presentation by scoring case content, clinical reasoning, presentation skills, and overall performance.
Presenter and Case Details
Presenter Name
*
First Name
Last Name
Role or Training Level
*
Please Select
Medical Student
Intern
Resident
Fellow
Attending Physician
Nurse Practitioner
Physician Assistant
Other
Case Title
*
Date of Presentation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Clinical Service / Department
Case Type
*
New Diagnosis
Follow-up
Acute Presentation
Chronic Condition Review
Other
Clinical Case Content Evaluation
History Taking Completeness
*
Incomplete
1
2
3
4
5
6
7
8
9
Complete
10
1 is Incomplete, 10 is Complete
Physical Examination Detail
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Diagnostic Reasoning
*
Weak
1
2
3
4
5
6
7
8
9
Strong
10
1 is Weak, 10 is Strong
Differential Diagnosis Quality
*
Limited
1
2
3
4
5
6
7
8
9
Comprehensive
10
1 is Limited, 10 is Comprehensive
Appropriateness of Investigations
*
Inappropriate
1
2
3
4
5
6
7
8
9
Highly Appropriate
10
1 is Inappropriate, 10 is Highly Appropriate
Management Plan Appropriateness
*
Inappropriate
1
2
3
4
5
6
7
8
9
Highly Appropriate
10
1 is Inappropriate, 10 is Highly Appropriate
Follow-Up Planning
*
Not Evident
1
2
3
4
5
6
7
8
9
Well Planned
10
1 is Not Evident, 10 is Well Planned
Clarity of Learning Points
*
Unclear
1
2
3
4
5
6
7
8
9
Very Clear
10
1 is Unclear, 10 is Very Clear
Presentation Skills and Professionalism
Organization and flow
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Clarity of speech
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Time management
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Audience engagement
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Slide or visual quality
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Professionalism and response quality during questions and discussion
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Evaluator Summary
Overall Score
*
1
2
3
4
5
Strengths of the Presentation
*
Areas for Improvement
*
Final Recommendation
*
Excellent
Satisfactory
Needs Improvement
Re-present
Additional Comments
Submit Evaluation
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