Internship Forms

Supervised Field Experience
Masters Program, Bioethics and Medical Humanities
Student: _____________________________________________________________________
Student Log – Due at conclusion of experience
Time sheet must be approved and confirmed by Site Supervisor
______________________________________ ______________________________________
Supervisor’s signature
Print name
Site: _________________________________ Date: ___________ Total Hours worked: __________
The reports require you to evaluate and reflect upon your field experience performance as well as your
academic and professional development during your placement. Please submit each reports on the
specified date by way of email to Dr. Nixon or to her designated staff person. Remember that you are
writing for three important audiences. You are the first, your MABMH Supervisor, and your Site Supervisor
is the third. The thinking you do now should help you sort a complex set of experiences into a coherent,
meaningful pattern, help you analyze and evaluate what has happened during this field experience, and
help you clarify your plans and priorities as you think about your future goals – academic, professional, and
personal. The reports should be word processed, double-spaced, using a 12-point font such as Times
Report #1 –
Due Date
Please include the following information in each report:
Supervisor’s telephone number:
Semester and year:
Before meeting with Dr. Nixon or her designated staff, please prepare typed answers for each of these
questions. If N/A, please indicate.
1. What is the mission and focus of the organization/department where you are serving your field
2. Describe your placement and responsibilities.
3. List and describe the opportunities for learning?
4. Do your actual activities fulfill your expectations? Please explain.
5. Do you have ample support to complete your field experience? Please describe.
6. Explain the feedback process.
7. How do you access your supervisor on the job and how often are you able to make contact?
(scheduled meetings, unscheduled meetings, office contact, other/specify)
8. Over the next few weeks, which areas will you focus on?
9. Where do you spend (physical location) the majority of your field placement hours?
10. Have you had any difficulties in scheduling your field experience hours around other course
requirements or your full-time employment (if applicable)?
11. Think about the challenges you face in your field experience. What are three things you could do, or
are already doing, to make the most of your experience? Please elaborate.
12. Please describe any problems, concerns or comments about your placement.
Report #2–
Due Date: __________________
Please include the following information in each report:
Supervisor’s telephone number:
Semester and year:
1. Review the Student Field Experience Plan you prepared at the beginning of the semester. For each
goal, write briefly about the following:
2. In hindsight, was this a good goal for you? Why?
3. How well are you achieving this goal? How do you know?
4. Have your goals changed during the field placement? If so, please elaborate, telling why and how
they changed and explaining how you met new goals.
5. List the two or three most important tasks you do/did as part of your job. Then rate how you think
you have performed each task on a scale from 1 to 5 as indicated below. Write brief comments
explaining your rating on each item.
Best possible Performance
Average / Satisfactory
Not as well as I would have liked
6. What task(s) did you like the most? Why?
7. What task(s) did you like the least? Why?
8. Review your expectations, perceptions and attitudes, from the beginning of the field experience. In
what ways has your understanding of yourself changed? Have you made any discoveries about
your technical, people and professional skills, values and interests?
9. What do you think are the three most important abilities/skills/characteristics that you developed as
a result of this placement?
10. What academic background or courses have proved valuable in performing this job?
11. What additional coursework and/or experience would be helpful in order to improve your success in
this or future placements?
12. What advice would you give to a student who was planning to serve his/her field experience at this
site in the future?
13. Considering the credit you received for the field placement, please compare it to the equivalent
credit for an on-campus course; in other words, if you served the field experience for three course
credits, compare the workload, stress, etc., to taking one course on campus.
14. What can you do now to make yourself more marketable as an MABMH graduate?
15. Please add any additional comments about your placement.
Report #3 – Due Date: ___________________
Please include the following information in each report:
Supervisor’s telephone number:
Semester and year:
Report #3 has two parts – a review of your student plan and one (or more) of the Three Levels of
At the conclusion of your field experience, revisit your original student plan. Examine your original goals and
objectives and discuss how you did or did not meet them. In other words, look at what you expected to
happen and what really happened. Reflect on the experience and how you were affected.
Also select from one or all of the following Three Levels of Reflection and answer the questions in depth.
Your reply may be based on the Mirror, the Microscope, or the Binoculars.
The ability to continuously reflect on your knowledge and activities will enhance your work life. Conscious
reflection will help you confront change, discover new possibilities and directions, and guide you toward
what you must continue to learn in order to succeed now and in the future.
The Mirror (A clear reflection of the self)
Who are you? What are your values? What have you learned about yourself through this experience? Do
you have more/less understanding or empathy than you did before this experience? In what ways, if any,
has your sense of self, your values, your sense of "community," your willingness to serve others, and your
self-confidence/self-esteem been impacted or altered through this experience? Have your motivations for
the MABMH degree work changed? In what ways? How has this experience challenged stereotypes or
prejudices you have/had? Any realizations, insights, or especially strong lessons learned or half-glimpsed?
Will these experiences change the way you act or think in the future? Have you given enough, opened up
enough, cared enough? How have you challenged yourself, your ideals, your philosophies, your concept of
life or of the way you live?
The Microscope (Makes the small experience large)
What happened? Describe your experience. What would you change about this situation if you were in
charge? What have you learned about this agency, these people, or the community? Was there a moment
of failure, success, indecision, doubt, humor, frustration, happiness, sadness? Do you feel your actions had
any impact? What more needs to be done? Does this experience compliment or contrast with what you're
learning in class? How? Has learning through experience taught you more, less, or the same as a class? In
what ways?
The Binoculars (Makes what appears distant, appear closer)
From your field experience, are you able to identify any underlying or overarching issues that influence the
problem(s) you addressed? What could be done to change the situation? How will this alter your future
behaviors/attitudes/and career? How is the issue/agency where you worked impacted by what is going on in
the larger political/social sphere? What does the future hold? What can be done?
Due Date ____________________
The abstract should be written in the third person and be phrased to offer the maximum amount of
information about the nature of your field placement in no less than 500 words. As these abstracts are
collected, they will be used to help future students learn about potential sites for field experiences and
special projects in a variety of venues and locations. All materials should be placed in a folder containing
the experience “name” and typed copies of all three reports.
The abstract should include the following:
 A complete description of the type of work completed by the student during the field experience
 Skills and knowledge future students should possess. Courses that they should take in advance
of the placement
 Potential opportunities for students in other departments at the site
 Contact information including: website, e- and US mailing addresses, phone and fax numbers,
name of the primary supervisor along with suggested procedures for initiating contact
Students should submit the following materials as an attachment to the abstract:
 Background/history about the agency and the community/clients it serves
 Information about the agency mission, goals and vision
 A listing of departments/projects/programs
 An annual report
 Brochures/annual report/marketing materials about the field placement site
In sum, students should share information that would have been useful to them when they were in the
process of selecting a field experience site.