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OB/Gyn Student Clerkship Evaluation Form:
Obstetrics Block
STUDENT NAME:___________________ DATE:____________
Knowledge and Skills Expectations:
(for your reference, will be tested on oral examination and shelf examination)
Students completing the Obstetric block
should be able to do the following:
1)
Obtain, present, and document a relevant history on patients being
evaluated or admitted; examinations will be done with supervising resident/
faculty
2) Interpret and document fetal heart rate monitoring strips
3) Assess and document labor course in patients, postpartum assessments
4) Write appropriate post-delivery orders (vaginal and C/S)
5)
Understand the normal hospital course for the patient after a
normal vaginal delivery or operative C/S delivery
Final Grade:
____________ (Honors, High Pass, Pass, Marginal)
Summary Comments
(comments suggested for Dean’s Letter of
Recommendation):
Constructive Comments
(for use of student and advisor in planning
future study; not for use in Dean’s letter):
Evaluator: ________________________________________
Signature
Printed Name
Updated
Last: August 3, 2003
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