Evaluations

Evaluations

Student Evaluation of Clerkship

Student:

Last Name

First Name

Clerkship:

Campus:

Rotation Dates:

Start Date

End Date

I. General Clerkship Organization and Curriculum

	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
1. Objectives of the clerkship were clearly communicated at the beginning of the clerkship
2. There was consistency among the clerkship director, preceptor, and department staff regarding objectives and expectations
3. Objectives and expectations were reasonable
4. Curriculum materials and required reading were relevant to clerkship objectives
5. Appropriate resources and assistance were available in meeting objectives
6. Grading criteria and examinations appropriately reflected clerkship objectives
7. The material learned this rotation is relevant to the over-all practice of medicine

Comments (Required Item): regarding organization and/or curriculum

II. Balance in the Curriculum

	Far too little	Too little	Appropriate	Too much	Far too much
8. Opportunities to observe
9. Time for questions and interaction with preceptor
10. Feedback from faculty and staff
11. Performance of procedures with supervision
12. Number of patient contacts
13. Variety of patient contacts
14. Time with patients
15. Time for case presentations
16. Time for required reading
17. Time for optional or suggested reading
18. Free time (recreation and family time)

Comments (Required Item): regarding balance in the curriculum

III. Progress and Confidence:

Please rate each of the following areas Twice. (Once regarding progress and once regarding confidence)

Area	Describe the amount of progress you made during this clerkship			How confident are you now?
Area	Major	Moderate	Minimal	Very	Somewaht	Minimally
19-20. History taking (in general)
21-22. Physical Exam (in general)
23-24. Diagnose common disorders (in general)
25-26. Diagnose common disorders relating to this clerkship
27-28. Treat or appropriately refer common disorders (in general)
29-30. Treat or appropriately refer common disorders related to this clerkship
31-32. Deal with special needs of patients and their families
33-34. Deal with ethical issues
35-36. Deal with patient education
37-38. Work and communicate well with other professionals as part of a health-care team
Family Medicine Clerkship Students Only
39-40. Skill level in performing the dermatologic exam
41-42. Skill level in performing the musculoskeletal exam
Internal Medicine Clerkship Students Only
43-44. Skill level in performing the cardiovascular exam
45-46. Skill level in performing the pulmonary exam
OB/GYN Clerkship Students Only
47-48. Skill level in performing the breast exam
49-50. Skill level in performing the pelvic exam
Pediatric Clerkship Students Only
51-52. Skill level in performing the pediatric exam (i.e., well child visit)
Psychiatry Clerkship Students Only
53-54. Skill level in performing the mental status exam
Surgery Clerkship Students Only
55-56. Skill level in performing the abdominal exam
57-58. Skill level in performing the genitourinary exam

Comments (Required Item): regarding progress and/or confidence

IV. Strengths and Weaknesses

59. What do you see as the 2 (or more) greatest strengths of this clerkship? (Required Item)

60. Please provide 2 (or more) constructive suggestions for the improvement of this clerkship. (Required Item)