Fellow Labor And Delivery Evaluation

Date:	(mm/dd/yyyy)	Student's CWID
Semester:		Student's First Name:
Preceptor's First Name:		Student's Last Name:
Preceptor's Last Name:		Student's CSUF Email:
Patient Identification: Parity: Delivery number(s):

NOTE: Please evaluate current level of functioning. Faculty will adjust grades per semester.

KEY:	NA	Cannot assess and/or unnecessary
	1	Unsatisfactory or unsafe
	2	Marginal to minimal competence. Significant omissions.
	3	Beginning level practice, requires close supervision
	4	Intermediate level practice, requires less than close supervision
	5	Advanced level practice, requires little supervision. Good grasp of CNM role

Each item as appropriate is to be evaluated for:
(a) accuracy (b) completeness (c) relevance/appropriateness (d) logical/systematic ordering (e) conciseness (f) legibility (g) hand skills

Part I: Management Process Evaluation (completed for all experiences)	Scale	Comments (eg., a-g)
Systematically obtains/updates data base	NA54321
Keeps staff informed of patient status	NA54321
Accurately identifies problems/needs/diagnoses	NA54321
Develops plan of management	NA54321
Implements plan of management	NA54321
Teaches/counsels well	NA54321
Recognizes deviations from normal and consults prn	NA54321
Reports/consults well orally	NA54321
Documents well in written form	NA54321
Evaluates and follows up care	NA54321
Demonstrates cultural sensitivity to the patient and her support system	NA54321

Part II: Initial Assessment	Scale	Comments (eg., a-g)
Chief complaint evaluated adequately	NA54321
Reviews medical/OB history and AP course	NA54321
Assesses socio/cultural/educational background	NA54321
Elicits patient perceptions and expectations	NA54321
Completes general physical examination	NA54321
Completes abdominal examination	NA54321
Completes pelvic examination	NA54321
Assesses fetal well-being/status	NA54321
Assesses labor status	NA54321
Orders and/or performs appropriate tests	NA54321
Writes appropriate admission orders	NA54321

Part III: Labor Management	Scale	Comments (eg., a-g)
Ongoing assessment of maternal health status	NA54321
Ongoing assessment of fetal health status	NA54321
Pelvic exams complete and appropriate	NA54321
Explains options to client and orders appropriate anesthesia/analgesia	NA54321
Amniotomy – timely and correct	NA54321
Appropriate preparation for delivery	NA54321
Facilitates efforts of mother’s support person	NA54321
Available to patient throughout the labor process	NA54321
Facilitates participative process with parents/family	NA54321
Provides for mother’s personal hygiene	NA54321
Uses appropriate relaxation, comfort, and therapeutic measures	NA54321
Provides for hydration – oral and/or IV	NA54321

Part IV. Delivery	Scale	Comments (eg., a-g)
Provides for appropriate delivery analgesia/ anesthesia	NA54321
Assesses need for and performs episiotomy	NA54321
Controls delivery; assess and manages nuchal cord	NA54321
Provides immediate newborn care	NA54321
Delivers and assesses placenta and membranes	NA54321
Control bleeding	NA54321
Performs cervical and vaginal inspection	NA54321
Assesses lacerations completely and accurately	NA54321
Repairs episiotomy and lacerations	NA54321
Maintains asepsis using appropriate technique	NA54321

Part V. Initial Postpartum Period	Scale	Comments (eg., a-g)
Assesses PP status completely and accurately	NA54321
Provides opportunity for parent-infant interaction	NA54321
Institutes appropriate postpartum measures/orders	NA54321
Maintains contact with mother throughout 4th stage unless delivery of another mother is imminent	NA54321

Comments/Suggestions (Preceptor and/or SNM; please explain any ratings less than 4):

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