Fellow Labor And Delivery Evaluation

Date:	*(mm/dd/yyyy) Invalid	Student's CWID	*Invalid
Semester:	* *	Student's First Name:	*
Preceptor's First Name:	*	Student's Last Name:	*
Preceptor's Last Name:	*	Student's CSUF Email:	* (Invalid Email Address)
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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