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
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