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| Observed competencies | Grading | |||
| Insufficient | Needs Improvement | Sufficient | Excellent | ||
| A | Discovers the reason for the patient attendance |
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| 1 | Encourages the patient’s contribution |
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| 2 | Responds to cues |
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| 3 | Places complaints in appropriate psychological context |
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| 4 | Explores patient’s health understanding |
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| B | Defines the clinical problem |
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| 5 | Includes or excludes likely relevant significant condition |
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| 6 | Conducts appropriate physical or mental state examination |
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| 7 | Makes an appropriate working diagnosis |
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| C | Explains the problem in appropriate language |
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| 8 | Explains the problem in appropriate language |
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| D | Addresses the patient’s problem |
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| 9 | Seeks to confirm the patient's understanding |
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| 10 | Provides an appropriate management plan |
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| 11 | Involves patient in management decisions |
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| E | Makes effective use of the consultation |
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| 12 | Makes effective use of resources |
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| 13 | Specifies conditions and interval for follow up |
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| Overall assessment |
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| Feedback and recommendations for further development |
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