Phase 1 one45 Assessment Form Checklist
CBM 101
CBL1 Mid
CBL1 End
TOS1 Mid
TOS1 End
SCS1 + PB1
Submission Due
Not Required
October 9, 2015
Not Required
October 9, 2015
October 9, 2015
CBM 102
CBL1 Mid
CBL1 End
TOS1 Mid
TOS1 End
SCS1 + PB1
Submission Due
October 16, 2015
November 20, 2015
October 16, 2015
November 20, 2015
November 20, 2015
CBM 103
CBL1 Mid
CBL1 End
TOS1 Mid
TOS1 End
SCS1 + PB1
Submission Due
November 27, 2015
January 4, 2016
November 27, 2015
January 4, 2016
January 4, 2016
CBM 104
CBL1 Mid
CBL1 End
TOS1 Mid
TOS1 End
SCS1 + PB1
H&V
Submission Due
January 22, 2016
February 26, 2016
January 22, 2016
February 26, 2016
February 26, 2016
February 26, 2016
CBM 105
CBL1 Mid
CBL1 End
TOS1 Mid
TOS1 End
SCS1 105 + PB1
Submission Due
March 4, 2016
April 22, 2016
March 4, 2016
April 22, 2016
April 22, 2016
CBM 106
CBL1 Mid
CBL1 End
TOS1 Mid
TOS1 End
SCS1 + PB1
ICE 106 Student must distribute
SSP
Submission Due
April 29, 2016
June 10, 2016
April 29, 2016
June 10, 2016
June 10, 2016
June 10, 2016
June 10, 2016
REVISION DATE: SEPT 22, 2015
CBM 107
CBL2 Mid
CBL2 End
TOS2 Mid
TOS2 End
SCS2 + PB2
Submission Due
September 11, 2015
October 16, 2015
September 11, 2015
October 16, 2015
October 16, 2015
CBM 108
CBL2 Mid
CBL2 End
TOS2 Mid
TOS2 End
SCS2 + PB2
ICE 108 Student must distribute
Submission Due
October 23, 2015
November 27, 2015
October 23, 2015
November 27, 2015
November 27, 2015
November 27, 2015
CBM 109
CBL2 Mid
CBL2 End
TOS2 Mid
TOS2 End
SCS2 + PB2
CBM 110
CBL2 Mid
CBL2 End
TOS2 Mid
TOS2 End
SCS2 + PB2
ICE 110 Student must distribute
CBM 111
CBL2 Mid
CBL2 End
TOS2 Mid
TOS2 End
SCS2 + PB2
Submission Due
December 4, 2015
January 22, 2016
December 4, 2015
January 22, 2016
January 22, 2016
Submission Due
January 29, 2016
March 4, 2016
January 29, 2016
March 4, 2016
March 4, 2016
March 4, 2016
Submission Due
April 1, 2016
April 29, 2016
April 1, 2016
April 29, 2016
April 29, 2016
Phase 1 – Year 1 Assessment Form Reference Guide
Document
Reference
CBL1 MID
CBL1 END
TOS1 MID
TOS1 END
SCS1
SCS105
PB1
ICE106
SSP
H&V
One45 Picklist Name
Assessment of the Learner for
CBL Mid-Module Year 1
Assessment of the Learner for
CBL End Module Year 1
Assessment of the Learner for
TOS Mid-Module Year 1
Assessment of the Learner for
TOS End Module Year 1
Assessment Structured Clinical
Skills End of Module (Except
CBM105)
Assessment Structured Clinical
Skills End of Module (CBM105)
Assessment of Prof Behaviour
in Clinical Encounters Y1
Assessment of Student
Performance in ICE106
Assessment: Self Study Project
Assessment: Heroes and Villains
Full Title on Assessment Form
Facilitator Assessment of the Learner for CBL MidModule in Year 1
Facilitator Assessment of the Learner for CBL End
Module in Year 1
Facilitator Assessment of the Learner for TOS MidModule in Year 1
Facilitator Assessment of the Learner for TOS End
Module in Year 1
Structured Clinical Skills End of Module Assessment
Year 1 (Except Module 105)
Structured Clinical Skills End of Module Assessment
Year 1 (Module 105)
Assessment of Professional Behaviour in Clinical
Encounters in Year 1
Assessment of Student Performance in the Integrated
Community Experience (ICE) – Module 106
Self-Study Project Assessment Form
Heroes and Villains Assignment CBM 104
Phase 1 – Year 2 Assessment Form Reference Guide
Document
Reference
CBL2 MID
CBL2 END
TOS2 MID
TOS2 END
SCS2
PB2
ICE108
ICE110
One45 Picklist Name
Assessment of the Learner for
CBL Mid-Module Year 2
Assessment of the Learner for
CBL End Module Year 2
Assessment of the Learner for
TOS Mid-Module Year 2
Assessment of the Learner for
TOS End Module Year 2
Assessment Structured Clinical
Skills End of Module Year 2
Assessment of Prof Behaviour
in Clinical Encounters Y2
Assessment of Student
Performance in ICE108
Assessment of Student
Performance in ICE110
Full Title on Assessment Form
Facilitator Assessment of the Learner for CBL MidModule in Year 2
Facilitator Assessment of the Learner for CBL EndModule in Year 2
Facilitator Assessment of the Learner for TOS MidModule in Year 2
Facilitator Assessment of the Learner for TOS End
Module in Year 2
Structured Clinical Skills End of Module Assessment
Year 2
Assessment of Professional Behaviour in Clinical
Encounters in Year 2
Assessment of Student Performance in the Integrated
Community Experience (ICE) – Module 108
Assessment of Student Performance in the Integrated
Community Experience (ICE) – Module 110
*Student must distribute*
Students will receive the assessment form directly in their one45 To Dos. During the first week of ICE placement, students are expected to select
their Preceptor from the drop down list to assign the form for completion. If Preceptor is not listed or the student does not know who to select,
they are to send an email to [email protected] promptly so that the issue can be resolved and the form distributed.
REVISION DATE: SEPT 22, 2015