Stanford University School of Medicine

Practice of Medicine
Stanford University Interview Check List

STANFORD INTERVIEW CHECKLIST

Student Name: Case Name:
ASSESSMENT

Unsatisfactory
Satisfactory
Excellent

Marginal
ITEM

N/A
Opening
O1: Allows pt to complete opening statement w/o interruption
O2: Asks to elicit full set of concerns
O3: Explains or negotiates an agenda for the visit
Relationship Skills
R1: Greets and shows interest in patient as a person; uses pt's name
R2: Introduces him/herself, shakes hand
R3: Aware of personal space. If pt not comfortable, don't force it
R4:Explains his/her role and the purpose of the interview
R5: Establishes initial rapport and patient comfort
R6: Uses words that show care and concern
R7:Uses tone, pace, eye contact and posture showing care/concern
Information Gathering
I1: Begins with the pt narrative using open ended questions
I2: Clarifies details as necessary using closed or yes/no questions
I3: Summarizes and checks accuracy with patient
I4: Transitions effectively to additional areas
Understands the patient's perspective:
I5a: Asks re. events, circumstances, other people that might affect health
I5b: Elicits pt's beliefs, concerns, expectations re. illness and treatment
I5c: Responds explicitly to patient statements re. ideas, feelings, values
Patient Education
P1: Assesses pt's understanding of the problem & desire for more info
P2: Explains using words patients understands
P3: Checks for mutual understanding of plan
P4: Asks if patient has any questions
Closing
C1: Asks if the pt has questions, or concerns for next time
C2: Summarizes (or asks pt to summarize) plans until next visit
C3: Clarifies follow-up or contact arrangements
Flow
F1: Interview moves smoothly from one component to another, with key
points summarized and ending with a smooth closure.

Professional Appearance & YES NO

History Data Base Conduct
Completed Satisfactory √ Satisfactory? √

Major Strengths Observed:

Areas for Improvement:

Date:
Interviewer: Evaluator:

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