STUDENT EVALUATION OF CLINICAL EXPERIENCE/MIDTERM
Student Name:
Internship Site:
Experience Started On:
1. What best describes your assessment of the Supervision and Guidance you typically received?
o
o
o
o
o
Need much more
Need a little more
Just Right
Need a little less
Need a lot less
Comments:
2. What best describes your assessment of the Progression of Responsibility?
o
o
o
o
o
Too slow
A little too slow
Just Right
A little too fast
Too fast
Comments:
3. Rate your assessment of the Frequency of Feedback and Discussion.
o Need more
o Need a little more
o Just Right
Comments:
4. What best represents your level of satisfaction with the overall type of feedback you received (i.e.
specific, balanced, constructive, timely, etc.)?
o
o
o
o
Very satisfied
Satisfied
Slightly satisfied, need some adjustments
Not satisfied, need significant changes
Comments:
1
5. What best represents your level of satisfaction with the achievement of your goals for this internship?
o
o
o
o
Very satisfied
Satisfied
Slightly satisfied, needed some adjustments
Not Satisfied
Comments:
6. In terms of your learning experience, what did you find most helpful?
7. Do you have any suggestions for your clinical instructor about how to make this a better learning
experience for you?
2
STUDENT EVALUATION OF CLINICAL EXPERIENCE/FINAL
Student Name:
Internship Site:
Experience Completed On:
1. What best describes your assessment of the Supervision and Guidance you typically received?
o
o
o
o
o
Needed much more
Needed a little more
Just Right
Needed a little less
Needed a lot less
Comments:
2. What best describes your assessment of the Progression of Responsibility?
o
o
o
o
o
Too slow
A little too slow
Just Right
A little too fast
Too fast
Comments:
3. Rate your assessment of the Frequency of Feedback and Discussion.
o Needed more
o Needed a little more
o Just Right
Comments:
4. What best represents your level of satisfaction with the overall type of feedback you received?
o
o
o
o
Very satisfied
Satisfied
Slightly satisfied, needed some adjustments
Not satisfied
Comments:
3
5. What best represents your level of satisfaction with the achievement of your goals for this internship?
o
o
o
o
Very satisfied
Satisfied
Slightly satisfied, needed some adjustments
Not satisfied
Comments:
6. In terms of your learning experience, what did you find most helpful?
7. Do you have any suggestions for your instructor about how to make this a better learning experience for
future students?
8. Please provide any other constructive feedback about this site you may want to share. What was helpful
and appreciated and what could be done differently to make the overall student experience even better?
4
STUDENT EVALUATION OF PRECEPTOR
Name of Clinical Instructor:
One (1) I Strongly Disagree
Two (2) I Disagree
Three (3) I Agree
Four (4) I Strongly Agree
CI was welcoming and supportive.
1.
2.
3.
4.
1.
2.
3.
4.
Appropriate time was allotted to discuss patient management.
1.
2.
3.
2.
3.
4.
Progression of responsibility was just right and challenged me appropriately.
1.
Comments:
CI allowed me to share my ideas and contribute.
Comments:
4.
Comments:
CI provided suitable levels of supervision and guidance.
1.
Comments:
2.
3.
4.
3.
4.
Comments:
CI was an excellent professional role model.
1.
2.
3.
4.
Comments:
Expectations & goals were appropriate & discussed early, often & revised if needed. 1.
2.
Comments:
Feedback was constructive and balanced.
1.
2.
3.
4.
Communication was good between CI and student. 1.
2.
3.
4.
2.
3.
4.
Comments:
Comments:
I would recommend this CI to future students
1.
Comments:
Please provide any additional comments about the clinical instruction you received at this site that
would be useful for future student development and planning.
5
6