Medical Internship Skills Evaluation

Intern Name

Department/Rotation

Supervisor Name

Date

Clinical Skills Evaluation

Skill	Excellent	Good	Needs Improvement	Comments
Patient History Taking
Physical Examination
Clinical Reasoning
Procedural Skills
Documentation

Professional Skills

Skill	Excellent	Good	Needs Improvement	Comments
Communication
Teamwork
Responsibility
Punctuality & Attendance

Strengths

Areas for Improvement

Supervisor Feedback

Supervisor Signature

Date