University of Minnesota Medical School
Evaluation of Clerkship/Rotation
Years 3 & 4
Clerkship Name:
__________________________________
Period:
__________________________________
Site:
__________________________________
Directions
• For each aspect of clinical rotation,
check the box which best describes your
clinical experience.
• Please use comments to describe
strengths and weaknesses. Give
examples whenever possible.
Please rate the following aspects of this clerkship based on your overall experience.
1. Learning environment: Faculty, residents, and staff demonstrate professional conduct and respect for
students.
2. Organization of course: Including logistics; timely distribution of materials; accessibility of course
director/site coordinator; clarity of communication about objectives, content, roles, responsibilities;
structured, with time to attend student and departmental activities.
3. Educational value: Including teaching/learning environment; clinical experiences and opportunities;
assessments related to clerkship objectives.
4. Teaching: By attending physicians, residents, fellows, other health professionals and staff.
5. Evaluation and feedback: Constructiveness and timeliness of feedback received.
6. Experience as a health care team member: Work with healthcare team; Felt like a member of the
team.
Below
Expectations
Meets
Expectations
Exceeds
Expectations
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7. Please explain or give examples to support area(s) rated “below expectations”. Please provide suggestions for improvements
(ie., technology, resources, support etc.).
8. Describe the strength(s) of this clerkship/rotation (ie., technology, resources, support etc.).
9. Balance of supervision and autonomy
10. Would you recommend this site [for this clerkship] to others?
Too much
shadowing
Good
balance
Too much
autonomy
□
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Probably Not
Likely
Definitely
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Yes
No
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11. Average number of hours on duty per week in the hospital/clinic, including night call.
12. Did you experience any mistreatment, abuse or harassment, E.g., racial/ethnic, gender,
sexual, sexual orientation, or other mistreatment such as being publicly belittled, being required to perform
personal services, such as baby-sitting or shopping? Please be assured that your answers to this question will
be confidential and that no resident, attending physician, preceptor or course director will be able to link
your name to this question.
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13. If you answered YES above, please comment.
14. Nomination for the Arnold P. Gold Humanism and Excellence in Teaching Award
Please nominate (if appropriate) a RESIDENT for the Distinguished Medical Resident Teaching Award. Please provide the resident’s name,
department, and a description as to why you would like to nominate this person. For more information visit:
https://www.mmf.umn.edu/academic/honors/distinguished_teaching.cfm.
15. Nomination for the Distinguished Clinical Teaching Award
Please nominate (if applicable) a FACULTY MEMBER for the Distinguished Clinical Teaching Award. Please provide the faculty member’s name,
department, and a description as to why you would like to nominate this person. For more information visit:
https://www.mmf.umn.edu/academic/honors/distinguished_teaching.cfm.
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