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.

NA  Cannot assess and/or unnecessary
Unsatisfactory or unsafe
Marginal to minimal competence. Significant omissions.
Beginning level practice, requires close supervision
Intermediate level practice, requires less than close supervision
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  
Keeps staff informed of patient status  
Accurately identifies problems/needs/diagnoses  
Develops plan of management  
Implements plan of management  
Teaches/counsels well  
Recognizes deviations from normal and consults prn  
Reports/consults well orally  
Documents well in written form  
Evaluates and follows up care  
Demonstrates cultural sensitivity to the patient and her support system  
Part II: Initial Assessment
Scale Comments (eg., a-g)
Chief complaint evaluated adequately  
Reviews medical/OB history and AP course  
Assesses socio/cultural/educational background  
Elicits patient perceptions and expectations  
Completes general physical examination  
Completes abdominal examination  
Completes pelvic examination  
Assesses fetal well-being/status  
Assesses labor status  
Orders and/or performs appropriate tests  
Writes appropriate admission orders  
Part III: Labor Management
Scale Comments (eg., a-g)
Ongoing assessment of maternal health status  
Ongoing assessment of fetal health status  
Pelvic exams complete and appropriate  
Explains options to client and orders appropriate anesthesia/analgesia  
Amniotomy – timely and correct  
Appropriate preparation for delivery  
Facilitates efforts of mother’s support person  
Available to patient throughout the labor process  
Facilitates participative process with parents/family  
Provides for mother’s personal hygiene  
Uses appropriate relaxation, comfort, and therapeutic measures  
Provides for hydration – oral and/or IV  
Part IV. Delivery
Scale Comments (eg., a-g)
Provides for appropriate delivery analgesia/ anesthesia  
Assesses need for and performs episiotomy  
Controls delivery; assess and manages nuchal cord  
Provides immediate newborn care  
Delivers and assesses placenta and membranes  
Control bleeding  
Performs cervical and vaginal inspection  
Assesses lacerations completely and accurately  
Repairs episiotomy and lacerations  
Maintains asepsis using appropriate technique  
Part V. Initial Postpartum Period
Scale Comments (eg., a-g)
Assesses PP status completely and accurately  
Provides opportunity for parent-infant interaction  
Institutes appropriate postpartum measures/orders  
Maintains contact with mother throughout 4th stage unless delivery of another mother is imminent  

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

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