There are 3 Forms that you will complete as part of the Selective.

1.  Interim Feedback Form. There is a PDF version of this form shown below. This is a very simple form with 3 areas to enter text. It is a place for the "Strengths" (areas done well), "Weaknesses" (areas requiring further work/development), and "Action Plan" (recommendations for learning) to be documented. The intention of this form is to capture what you say to the student at the midway point of the Selective. This form is NOT MANDATORY, but can be very helpful.

Clerkship Interim feedback form

2.  Clinical Assessment Form. This form is MANDATORY. There is a PDF version of this form at the bottom of this page, entitled "Clinical Assessment Form". This shows you the grid which you will use to describe your final assessment of the student's progress by the end of the Selective. Here is how the ratings on the 1-5 scale at the top should be understood:

  • Unsatisfactory = Clearly failed; most likely will fail the evaluation.
  • Below Expectations = Barely passed, and you have concerns about this area.
  • Meets Expectations = Clearly passed.
  • Exceeds Expectations = Highly advanced performance in this area.
  • Outstanding = Rare degree of proficiency for this area given the stage of training.
  • N/A = You did not observe this in any way, and/or it does not apply to your setting.  Do not be afraid to use this if you really don't feel you can evaluate an area.

In addition to the above, you will find text boxes for comments to help the student understand what they are doing well, and what they need to improve on. You should also give them guidance on how to improve.  

The last question is a global impression - do you think they are ready to be a resident? This is very subjective, but we want to get your "gut feeling" of this student's performance overall. If you indicate concerns, we may be in touch with you to find out more.

Clerkship Clinical Assessment Form

3.  Professionalism Assessment Form. This form is MANDATORY. The form attached below is a reproduction of the form you must fill out on MedSIS at the same time as the Final Assessment. In this form, a Major Lapse or several Minor Lapses may be grounds for failing the Selective, and may delay graduation. A Critical Incident is one in which a major lapse led to problems with a patient's health or well-being. See the Professionalism page for more details.

Clerkship Professionalism Assessment Form