Table 2.

Criterion-based Acting Internship Summative Evaluation (Please CIRCLE the descriptor that best matches the student’s current ability)

Medical knowledge	Demonstrates only basic knowledge of pathophysiology and common treatments plans	Possesses acceptable knowledge of pathophysiology and major treatments. Occasional difficulty applying knowledge to patient care	Demonstrates in-depth knowledge of core pathophysiology and ability to readily apply this to patient care
Procedural knowledge and communication (ICU/surgery)	Unable to consistently demonstrate the knowledge of indications, benefits, or contraindications of procedures	Demonstrates partial knowledge of the indications, contraindications, risks, and benefits of common procedures	Demonstrates understanding of the indications, contraindications, risks, and benefits of common procedures
Clinical reasoning and decision-making	Able to perform complete history and physical exam with appropriate differential diagnoses but has difficulty assimilating new data	Able to perform complete history and physical exam. Emerging skills at selecting and interpreting relevant data. Offers independent suggestions for management	Incorporates relevant physical exam and history into assessment and treatment plan. Reassesses patient and changes care plan based on changes in clinical status
Documentation	Notes are often vague with inability to document rationale and formulate differential and daily plan	Notes contain all required elements with appropriate detail but often not concise. Conveys basic understanding of the assessment and plan	Notes are well-written, explaining the medical-decision making and plan. Easily and reliably assimilates new data into documentation
Ability to recognize acute changes in clinical status	Inconsistently recognizes changes in clinical status and acutely ill patients. At times, able to triage the patient but with limited knowledge of when to escalate care	Able to frequently recognize changes in clinical status and acutely ill patients. Developing skills to determine when to escalate care	Able to consistently recognize changes in clinical status and acutely ill patients. Knows limitations of the clinical scenario and repeatedly demonstrates ability to escalate care when needed
Patient handoffs (verbal and written)	Performs handoffs that are often not organized or succinct. Written handoff often not updated and may exclude essential information	Able to perform written and verbal handoffs that conveys most essential information with few lapses. Often too verbose or brief	Provides succinct, organized verbal and written handoffs; includes anticipatory guidance, follow-up with provisions, and emphasizes patients that are unstable
Professionalism	Demonstrates intermittent issues with respect, compassion, and integrity when dealing with patients and peers. Often does not follow through own responsibilities	Demonstrates basic respect, compassion, and responsibility. Completes all assigned tasks with direction	Demonstrates respect, compassion, and integrity. Demonstrates accountability and dependability in independently carrying out responsibilities
Limitations and initiative	Often does not acknowledge own limitations or take initiative	Able to self-identify some knowledge gaps with prompting. Does not necessarily demonstrate self-initiative in helping team and patients	Takes initiative to identify and address needs of patient and team. Able to identify own knowledge gaps and makes effort to improve gaps and patient care
Response to feedback	Does not frequently seek feedback and often is unaccepting of feedback	Appears to be accepting of feedback and sometimes utilizes it for improvement	Accepting of feedback. Demonstrates improvement reflective of feedback
Interpersonal and communication skills	Demonstrates difficulty effectively explaining medical condition to patient	Usually communicates to patients and family members effectively, though at times uses medical jargon	Communicates with the patients and family members utilizing appropriate terms. Effectively communicates with all members of the health care team
Respect of the patient and their personal/cultural preferences	Frequently unable to identify patient values that may impact patient care	Consistently demonstrates respect for patients, emerging ability to perform patient-centered care	Demonstrates appreciation for the cultural sensitivities of the patient and incorporates this into interactions and health care decision-making
Practice-based learning and improvement/life-long learning	Does not independently seek to advance knowledge on new topics and patient care issues	Seeks information and literature to advance knowledge and decision-making. Intermittent difficulty applying new knowledge or requires prompting	Uses references to access evidence-based medicine to solve clinical problems and advance medical knowledge
System-based practice	Demonstrates basic knowledge of the resources available in the hospital and community that contribute to effective patient care	Possesses basic knowledge of resources available and recognizes value, but has some difficulty utilizing on a regular basis	Utilizes resources available in the hospital and the community to advance patient care
The following questions are only required for Acting Interns on surgical services (including OB-GYN, Gen Surgery, Trauma, and Ortho)
Surgical anatomy	Lacks understanding of relevant surgical anatomy	Possesses basic understanding of surgical anatomy relevant to patient disease	Demonstrates in-depth understanding of surgical anatomy and operative procedures. Able to discuss effect on clinical disease
Principles of perioperative management	Demonstrates difficulty articulating basic principles of perioperative management	Able to identify pertinent medical history that could impact surgical outcomes. Needs assistance identifying patients appropriate for operative intervention	Identifies pertinent medical history and factors that may impact surgical outcomes. Offers independent suggestions for risk modification; identifies patients too high risk for operative intervention
Surgical decision making	Articulates indications for surgery but unable to consistently explain risks and alternatives	Able to discuss indications and alternatives for surgery with minor omissions	Comprehends and independently explains risks, alternatives, and benefits of procedures
Surgical dexterity and wound closure	Often unable to tie basic surgical knot or effectively close basic surgical incision	Demonstrates proficiency in basic knot tying and wound closure with occasional need for assistance	Effectively closes surgical wounds. Independently assists and anticipates surgical steps within procedures

Length of time with AI: (drop down menu of choices: 3 days or less, 4 days–1 week, 1–2 weeks, > 2 weeks)

Evaluator level of training (intern, resident, fellow, attending) —drop down menu of choices

In the following sections, please provide specific feedback to the degree possible:

Formative comments (areas for improvement): free text box

Summative comments (overall impression/assessment of student and their performance): free text box