PROGRESS STUDENT REFERRAL
Referrer's Name
Referrer's Email
Title
Please select...
Course director
Clerkship director
PCE site director
Sub-l director
Advisor
Other
Other title
Name of student being referred
Email of student being referred
Referred student's curricular phase
Other curricular phase
Please indicate any areas of concern
Professional
behavior
and
/or development
[examples: difficulty navigating the learning environment and/or teams, difficulty in accepting feedback or recognizing unproductive behaviors, delays in assignments or communications, inappropriate behaviors or boundary setting, below overall expected level of professionalism develo
pment]
Clinical
skills
development
[
examples: difficulty organizing a patient encounter,
notes,
oral presentations; issues with
using
a hypothesis-driven approach
to
patient encounters;
difficulty
building on
medical knowledge pertinent to clinical experiences].
Medical
knowledge
acquisition
an
d/or i
ntegration
[examples: difficulty in building or applying medical knowledge in foundational pre-PCE courses; see clinical skills development above for medical knowledge development in clinical experiences]
Organizational
skills
[examples: difficulty in building or applying medical knowledge in foundational pre-PCE courses; see clinical skills development above for medical knowledge development in clinical experiences]
Study
strategies
[examples: difficulty with pre-PCE foundational and classroom courses; difficulty in clinical courses and rotations/Practice of medicine, PCE, or Post-PCE]
Standardized
tes
t-taking
skills
[examples: difficulty with Step 1 or 2/study schedule, consolidating knowledge, vignette questions; difficulty with
shelf exams/study schedule, building knowledge, aligning knowledge-building with clinical learning, vignette questions]
Other
[examples
:
difficulty
balancing competing priorities; difficulty i
n seeking support]
Other areas of concern
*Please note, this referral information does not preclude any necessary one-on-one confidential communication with PROGRESS representatives or the Associate Dean for Assessment and Evaluation at any time. Any follow up conversations are welcomed.
Description of concern
Please provide a brief description of the student’s academic performance, observations of skill or behaviors, any guidance/coaching/advice that has been given to assist the student in improvement, and the student’s response to said guidance.
Has the student been informed that a PROGRESS referral is being made?
Yes
No
Has the student's academic society been informed about these concerns?
Yes
No
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