Evaluations

Evaluations

Student Evaluation of Preceptor Performance

Student:

Last Name

First Name

Preceptor:

Last Name

First Name

Clerkship:

Campus:

Rotation Dates:

Start Date

End Date

Indicate the extent to which your preceptor demonstrated the following characteristics

	Not at All	Minimal Extent	Moderate Extent	Great Extent	N/A
1. Is clear and organized
2. Takes time to explain things and answer questions
3. Establishes rapport with students
4. Actively involves students
5. Is knowledgeable and analytical
6. Asks good relevant questions leading to improved problem solving
7. Clearly communicates roles and expectations
8. Provides prompt positive and negative feedback
9. Helps students improve spoken and written communication
10. Provides positive professional and ethical model (good bedside manner)

Family Medicine Clerkship Students Only

	Not at All	Minimal Extent	Moderate Extent	Great Extent	N/A
11. Helped me improve my skill level in performing the dermatologic exam
12. Helped me improve my skill level in performing the musculoskeletal exam

Internal Medicine Clerkship Students Only

	Not at All	Minimal Extent	Moderate Extent	Great Extent	N/A
13. Helped me improve my skill level in performing the cardiovascular exam
14. Helped me improve my skill level in performing the pulmonary exam

OB/GYN Clerkship Students Only

	Not at All	Minimal Extent	Moderate Extent	Great Extent	N/A
15. Helped me improve my skill level in performing the breast exam
16. Helped me improve my skill level in performing the pelvic exam

Pediatrics Clerkship Students Only

	Not at All	Minimal Extent	Moderate Extent	Great Extent	N/A
17. Helped me improve my skill level in performing the pediatric exam (i.e., well child visit)

Psychiatry Clerkship Students Only

	Not at All	Minimal Extent	Moderate Extent	Great Extent	N/A
18. Helped me improve my skill level in performing the mental status exam (or neurological exam if evaluating a neurologist)

Surgery Clerkship Students Only

	Not at All	Minimal Extent	Moderate Extent	Great Extent	N/A
19. Helped me improve my skill level in performing the abdominal exam
20. Helped me improve my skill level in performing the genitourinary exam

	Poor	Fair	Good	Excellent
21. Overall Teaching Effectiveness

22. How many patient contact hours did you have under the supervision of this preceptor?

23. How many contact hours did you have with this preceptor?

14. What are this preceptor's strengths? (List at least 2) (Required Item)

15. Please provide constructive suggestions that could be used by this preceptor to improve future clerkships. (List at least 2) (Required Item)