Assessment of Students - Interprofessional Social & Ethical Dilemmas in Healthcare

To be completed by facilitator for each student after final presentation/discussion for each case

FACILITATOR NAME *
TEAM MEMBER (Student you are evaluating) *
CASE *
RESPECTFUL COMMUNICATION
1. Communicates with others in a disrespectful manner
2. Occasionally communicates with others in a confident, assertive and respectful manner
3. Frequently communicates with others in a confident, assertive and respectful manner

Please enter the score (1-3) below based on what you have observed. Enter "0" if respectful communication was not observable. *
Must be a number less than or equal to 3.
ROLES & RESPONSIBILITIES
1. Does not describe one’s own role and responsibilities with the team/patient/ family
2. Occasionally describes one’s own role and responsibilities with the team
3. Consistently describes one’s own roles and responsibilities with the team

Please enter the score (1-3) below based on what you have observed. Enter "0" if roles & responsibilities was not observable. *
Must be a number less than or equal to 3.
SHARING EVIDENCE-BASED/BEST PRACTICE KNOWLEDGE
1. Does not share evidence- based or best practice discipline-specific knowledge with others
2. Occasionally shares evidence-based or best practice discipline-specific knowledge with others
3. Shares evidence-based or best practice discipline- specific knowledge

Please enter the score (1-3) below based on what you have observed. Enter "0" if sharing evidence-based/best practice knowledge was not observable. *
Must be a number less than or equal to 3.
SHARED LEADERSHIP
1. Does not recognize the importance of alternating or sharing leadership with others
2. Occasionally shares leadership and alternates leadership with others when appropriate for the discipline involved
3. Consistently shares leadership and alternates leadership with others when appropriate for the discipline involved

Please enter the score (1-3) below based on what you have observed. Enter "0" if shared leadership was not observable. *
Must be a number less than or equal to 3.
RESPECT FOR DIFFERENT PERSPECTIVES
1. Does not consider the perspectives and opinions of others
2. Occasionally seeks the perspectives and opinions of others
3. Consistently seeks the perspectives and opinions of others

Please enter the score (1-3) below based on what you have observed. Enter "0" if respect for different perspectives was not observable. *
Must be a number less than or equal to 3.
TEAM DISCUSSION
1. Does not view themselves as part of the team
2. Frequently demonstrates
recognition of themselves as part of a team
3. Consistently demonstrates recognition of themselves as part of a team

Please enter the score (1-3) below based on what you have observed. Enter "0" if team discussion was not observable. *
Must be a number less than or equal to 3.
PLEASE ENTER THE TOTAL SCORE FOR THE TEAM MEMBER YOU ARE EVALUATING. *