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Prison Medicine - The College of Family Physicians Canada

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Version March 12, 2008I. APPENDIX 3 UBC DEPARTMENT OF FAMILY PRACTICEDAILY PRISON MEDICINE EVALUATION FORMRESIDENT:DATE:Preceptor:To the prison preceptor: Please rate the resident’s performance relative to yourself as a standard, i.e. would youhave done any more or less in the context <strong>of</strong> the problems encountered during today. (S - satisfactory; NI - needsimprovement; E - effective). Please fill in one form at the end <strong>of</strong> every day that the resident works with you.Subjective: History-taking, eliciting appropriate information.Awareness <strong>of</strong> important facts (cues). Problem solving abilities(making appropriate hypothesis).Objective: Skills <strong>of</strong> physical exam; ability to detect obvious signs;appropriateness <strong>of</strong> exam.NI S EAssessment: <strong>The</strong> interaction <strong>of</strong> history and physical findings andrating the urgency <strong>of</strong> the problem.Planning: Appropriate use <strong>of</strong> lab for investigation; therapeuticskills. Use <strong>of</strong> other health personnel; pattern <strong>of</strong> referral.Doctor/Patient Relationship: Empathy, attitude, ethics andinterviewing skills.Efficiency: Organization, termination, use <strong>of</strong> available time.Pr<strong>of</strong>essionalism: interactions with prison inmates, other clinicians& staff; punctuality; demeanour; etc.Nature <strong>of</strong> Patient Problem(s) encountered today:1.Other Comments:Recommendations for improving specific skills:2.Above discussed with resident YesNoPage 9 <strong>of</strong> 11

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