Final Preceptor Evaluation for the Rotation
100%
Questions marked with an * are required Exit Survey
 
 
Preceptor Name:
   
Student Name:
   
Student ID:
   
Hospital/Site:
   
Rotation:
   
Start Date:
   
End Date:
   
Number of weeks:
   
Date of Evaluation:
   
 
 
Please evaluate in context of student's level of training. If you cannot evaluate, please circle N/A. 1 = Substandard; 2,3,4,5 = Marginal to Adequate; 6,7,8 = Competent to Proficient; 9, 10 = Outstanding
1 2 3 4 5 6 7 8 9 10 N/A
H&P/Case Presentation: Complete, organized, appropriate, differentiates normal and abnormal findings, and presents differential/final diagnosis (Assessed Skills: Prioritizes H&P data; reviews vital signs and abnormal findings; provides a patient management plan.)
Clinical Judgment: Independently uses data to reach diagnosis and management; understands basic principles of the clinical case. (Assessed Skills: Focuses on relevant and important data; uses reasoning strategies appropriately; accessing, interpreting and applying EBM literature; focuses on possible interventions to improve patient’s condition.)
Patient Care: Provides compassionate care that is effective for health promotion, wellness, disease treatment, and end of life care. (Assessed Skills: Performs patient interviews; uses judgment; is respectful of patient preference.)
Medical Knowledge: Demonstrates knowledge of current biomedical, clinical epidemiological, and social sciences and applies that knowledge effectively to patient care. (Assessed Skills: Degree of knowledge base, committed to life-long learning; has understanding of complex problems)
Practice-Based Learning and Improvement: Understands evidence-based medicine and applies sound principles of practice within the context of patient care. (Assessed Skills: Self-assesses; uses new technology; accepts feedback)
Interpersonal and Communication Skills: Demonstrates skills (i.e. listening and responding) that result in effective information exchange between patients/families and the healthcare team. (Assessed Skills: Establishes relationships with patients/families; educates and counsels patients/families; maintains comprehensive, timely, legible medical records.)
Professionalism: Demonstrates commitment to professional development and ethical principles, and sensitivity to patient/family and peer diversity. (Assessed Skills: Shows compassion, respect, and honesty; accepts responsibility for errors; considers needs of patients/colleagues.)
Cultural understanding: Works in a multicultural environment to develop a high level of cultural awareness in order to successfully interact with a diverse client group and uphold professional standards and acceptable healthcare outcomes. (Assessed Skills: Development of cultured awareness as an ongoing process; integrates the patients’ health care preferences into a case management plan because of trust.)
 
 
 
Preceptor: Please mention strengths and weaknesses as well as areas for improvement below.
   
Row 2
   
 
 
 
* Preceptor Signature
   
 
 
 
Please sign here