Download Annual Clinical Skills Evaluation of Residents in Psychiatry

Office of Postgraduate Education  Centre for Addiction & Mental Health, College St. Site
250 College Street, Suite 828 • Toronto ON M5T 1R9  Canada  Tel: 416-979-6911  Fax: 416-979-6928
PGY 2 – PGY 5 MOCK ORAL EVALUATION FORM
(Resident must complete 3 Mock Oral Examinations during each 6-month rotation)
The Mock Oral Evaluation form covers several domains including the psychiatric interview, case presentation, differential diagnosis,
formulation and management. For each item listed on the evaluation tool, we ask that you use the following scoring-system:
Score of 1 - 4
Score of 5 - 6
Score of 7 - 8
Performs below the level of a PGY2 resident
Performs at a Junior Resident level (PGY2 & PGY3)
Performs at a Senior Resident level (PGY4 & PGY5)
The resident’s overall performance on the mock oral should be determined by the examiner’s global impression of the examinee’s
performance. This means that residents may score below their expected level on selected items but may excel in a majority of areas
resulting in an “acceptable” score overall.
Items that are bolded relate to domains that are expected of Senior residents. These items should still be scored for Junior residents
for the purpose of feedback but should not be factored into the global overall evaluation of the junior resident’s performance.
Resident Name:
Year of Training:
Date/Time:
Day/Month/Year
Interview Start Time
Evaluator Name:
Interview End Time
Hospital:
 Your performance on today’s evaluation based on your level of training was:
Pass
Fail
Patient Description A snap shot of the patient that includes, age, gender, likely diagnosis and other relevant identifying factors.
Patient Difficulty Specify here any unique patient characteristics (e.g., language issues, disabilities, psychopathology) that clearly
makes establishing and maintaining the doctor-patient relationship and/or interviewing the patient more difficult:
1.0
Physician-Patient Relationship (Total)
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8
1.1
Introduces self, role and circumstances
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Comment:
1.2
Maintains appropriate eye-contact
Comment:
Page 1 of 9 Mock Oral Evaluation Form
1.3
Appears genuinely interested
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8
Comment:
1.4
Remains supportive throughout
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Comment:
1.5
Body language suggests active listening
Comment:
1.6
Responds appropriately to patient
Comment:
1.7
Develops rapport with patient
Comment:
1.8
Sustains rapport with patient
Comment:
1.9
Engages patient in a culturally appropriate
manner
Comment:
1.10
Smoothly closes the interview
Comment:
1.11
Provides a pertinent closing statement
Comment:
2.0
Interview and MSE (Total)
1
2
3
4
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8
2.1
Appears confident
1
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Comment:
2.2
Maintains control of the interview
Comment:
2.3
Non-verbal behaviour encourages patient to tell
his/her story
Comment:
2.4
Verbal behaviour encourages patient to tell
his/her story
Comment:
2.5
Listens attentively
Comment:
Page 2 of 9 Mock Oral Evaluation Form
2.6
Reframes when required
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Comment:
2.7
Note-taking is inconspicuous
Comment:
2.8
Asks clear questions in plain language
Comment:
2.9
Avoids leading questions
Comment:
2.10
Avoids stacked (multiple) questions
Comment:
2.11
Moves appropriately between open and closed
questions
Comment:
2.12
Maintains a logical sequence to questions
Comment:
2.13
Pursues detail and seeks appropriate
clarification required
Comment:
2.14
Bridges between the different sections of the
interview
Comment:
2.15
Comfortably allows silence to facilitate further
expression
Comment:
2.16
Facilitates expression of emotions
1
2
3
4
Comment:
2.17
Acknowledges patient’s distress with empathic
responses
1
2
3
4
Comment:
2.18
Appropriately utilizes patient’s non-verbal
communication
1
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3
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8
1
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3
4
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6
7
8
Comment:
2.19
Appropriately responds to affective cues
Comment:
Page 3 of 9 Mock Oral Evaluation Form
2.20
Appropriately responds to informational cues
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Comment:
2.21
Appropriately deals with unusual, difficult or
distressing content
Comment:
2.22
Appropriately adapts the interview and MSE to
be cultural competent
Comment:
2.23
Supportively confronts inconsistencies
Comment:
2.24
Summarizes when appropriate
Comment:
2.25
Attends to timing
Comment:
2.26
Interview Content
Obtains demographic information
Comment:
2.27
Obtains data on presenting problem(s)
Comment:
2.28
Obtains History of Presenting Illness
Comment:
2.29
Assesses pre-morbid state
Comment:
2.30
Assesses stressors related to presenting illness
Comment:
2.31
Identifies social and cultural stressors and
systemic inequities
Comment:
2.32
For episodic illnesses, identifies number of
previous episodes
Comment:
2.33
For episodic illnesses, identifies
differences/similarities with this episode
Comment:
Page 4 of 9 Mock Oral Evaluation Form
2.34
Identifies treatment interventions for this illness
episode
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Comment:
2.35
Reviews ‘A’ criteria for symptoms of illnesses in
the differential diagnosis
Comment:
2.36
Reviews ‘A’ criteria for symptoms of likely
comorbid diagnoses
Comment:
2.37
Explores patient’s explanatory model of
illness
Comment:
2.38
Completes an appropriate risk assessment (selfharm, aggression, self-care, competency)
Comment:
2.39
Reviews current medications and over-thecounter products quantifying dose, side-effects
and effectiveness
Comment:
2.40
Reviews complementary and alternative
treatments
1
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8
2.41
Defines allergic status
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Comment:
2.42
Reviews substance use/abuse
Comment:
2.43
Reviews Medical History
Comment:
2.44
Reviews Psychiatric History
Comment:
2.45
Reviews Forensic History
Comment:
2.46
Reviews Family History
Comment:
Page 5 of 9 Mock Oral Evaluation Form
2.47
Reviews Developmental History
i) Childhood
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Comment:
2.48
ii) Adolescence
Comment:
2.49
iii) Adult
Comment:
2.50
iv) Reviews relevant cultural identities,
migration history/trauma/stress,
acculturative strategies, and spirituality
1
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7
8
2.51
v) Identifies social and cultural supports
including family, kin networks, and communities
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Comment:
2.52
vi) Relationship History
Comment:
2.53
vii) Occupational History
Comment:
2.54
Conducts formal Mental Status Examination as
indicated
Comment:
3.0
3.1
Case Presentation (Total)
Presents case in an orderly and systematic
manner
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Comment:
3.2
Accurately presents relevant social and cultural
issues and their impact on presentation and
diagnosis
Comment:
3.3
Accurately reports the Mental State Examination
Comment:
3.4
Presents case in a concise manner yet includes
relevant details
Comment:
3.5
Presentation includes the necessary information
to support the chosen preferred diagnosis
Comment:
Page 6 of 9 Mock Oral Evaluation Form
3.6
Presentation enhances understanding of the
person with the illness
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8
Comment:
3.7
Accurately summarizes the risk assessment
(self-harm, aggression, self-care, competency)
Comment:
3.8
Accurately identifies deficits in the completed
history, their relevance to the case and provides
strategies for correcting those deficits
Comment:
3.9
Provides a realistic, multi-axial working
diagnosis supported by evidence from the
interview
Comment:
3.10
Identifies relevant comorbidities
Comment:
3.11
Provides a brief, differential diagnosis supported
by evidence from the interview
Comment:
3.12
Defends the differential diagnosis and outlines
strategies to further clarify the diagnosis when
asked
Comment:
4.0
Formulation (Total)
4.1
Identifies the major factors affecting the patient’s
health (protecting; predisposing; precipitating
and perpetuating factors)
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Comment:
4.2
Accurately identifies biological components of
the patient’s illness
Comment:
4.3
Accurately identifies psychological components
of the patient’s illness
Comment:
4.4
Accurately identifies social and cultural
components of the patient’s illness
Comment:
4.5
Able to identify prominent internal conflicts
and/or cognitive distortions that influence
the patient’s presentation
Comment:
Page 7 of 9 Mock Oral Evaluation Form
4.6
Able to identify problematic ways of relating
to others that influence the patient’s
presentation
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Comment:
4.7
Able to provide an integrated and accurate
formulation that enhances the understanding
of the patient with the illness.
Comment:
5.0
Treatment Plan (Total)
5.1
Identifies further bio-psycho-social-cultural
investigations immediately required to
consolidate the diagnosis or provide optimal
care of the patient
5
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Comment:
5.2
Provides a realistic treatment plan covering
immediate, short term, and long term goals
Comment:
5.3
Able to recommend and defend appropriate,
specific pharmacotherapies with an appraisal of
the risks and benefits for the patient.
Comment:
5.4
Able to consider social and cultural factors in all
aspects of treatment planning
Comment:
5.5
Able to recommend and defend appropriate
collaborations with family, community, or other
service providers
Comment:
5.6
Able to recommend and defend appropriate,
specific psychotherapies with an appraisal of the
risks and benefits for the patient.
Comment:
5.7
Able to address issues that may impact recovery
beyond symptom reduction
Comment:
Page 8 of 9 Mock Oral Evaluation Form
COMMENTS:
STRENGTHS. The following behaviors contributed to your effectiveness:
1.
2.
3.
WEAKNESSES. You should consider decreasing or stopping the following behaviors:
1.
2.
3.
RECOMMENDATIONS. To increase your effectiveness, you may wish to consider beginning or doing more of
the following:
1.
2.
3.
Resident Signature:
Evaluator Signature:
Thank you…
Please return the completed form to your hospital Postgraduate Coordinator
Please Fax To: 416-979-6928 ATTN: Sue Eccles
Page 9 of 9 Mock Oral Evaluation Form