STUDENT EVALUATION OF PRECEPTOR
Please return to: Dana Bailey baileyd@etsu.edu; Fax 423-439-8004
Student Name:
Physician Information
First Name:
MD:
DO:
Practice Name:
Mailing Address:
Practice Street Address:
City, State, Zip:
Telephone:
MI:
Last Name:
Other:
Fax:
1.
How were your professional skills enhanced?
2.
How was your medical knowledge increased?
Preceptor Email:
3.
How did the level of patient care match your ability and level of training?
Level of patient care was above my ability and level of training.
Level of patient care was about right for my ability and level of training.
Level of patient care was below my ability and level of training.
Further Comments:
4.
How did this experience increase your comprehension of a community health care provider?
5.
How would you rate the preceptor’s interaction with you?
The preceptor was well organized and easy to follow.
The preceptor gave clear explanations and made good use of examples and illustrations.
The preceptor was accessible to me.
The preceptor's conduct was professional.
The preceptor treated me with respect.
Further Comments:
6.
My overall evaluation of this preceptor is: (Please choose one)
Excellent
Good
Satisfactory
Marginal
Poor
Further Comments:
7.
What did you learn about primary care?
8.
What were the strengths and weaknesses of this experience?
9.
Would you recommend this preceptor to:
M1
M2
Both M1 and M2