Faculty of Medicine, University of Toronto
ELECTIVE EVALUATION BY STUDENT (Clinical)
International Medical Students
Should be sent to: medicine.intelective@utoronto.ca
 Please print or type clearly and fill out a separate form for each supervisor
STUDENT'S NAME:
______________________________________________________________________________________________________________________
ELECTIVE TITLE:
______________________________________________________________________________________________________________________
ELECTIVE LOCATION:____________________________________________________________
ELECTIVE DATES: ____________________________ TO ____________________________
ELECTIVE COORDINATING SUPERVISOR:_____________________________________________TELEPHONE#_______________________
ELECTIVE SUPERVISOR:______________________________________________________________________________________________
(Please fill out a separate form for each supervisor)
ELECTIVE FORMAT:
Block:  2 Week  3-4 Weeks  5-6 Weeks  7-8 Weeks
This information is for the purpose of Elective evaluation.
Information from this form will be provided with student identification removed, as feedback to supervisors.
Please evaluate how well the elective experience met the objectives agreed upon between & you and your supervisor at the
beginning of the elective
1 - Unsatisfactory 2 - Acceptable 3 - Good 4 - Very Good 5 - Excellent
SPECIFIC OBJECTIVES (list briefly)
1)
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5
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5
1
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5
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3
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5
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5
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5
2)
3)
4)
To what extent were additional objectives met. Please List:
5)
6)
Strongly
Disagree
Disagree
Agree
Strongly
Agree
The supervisor(s) was (were) available for discussion & feedback.
1
2
3
4
The supervisor(s) was (were) effective with their discussion & feedback.
1
2
3
4
The supervisor(s) contributed to meeting the learning objectives
1
2
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4
COMMENTS:
Too Little
Just Right
Too Much
Amount of Clinical Experience
1
2
3
Variety of Clinical Experience
1
2
3
Opportunities for Self-Directed Learning
1
2
3
COMMENTS:
How did you find out about this elective?
Online Catalogue

From Another Student

From Faculty Member 
Other? Please Indicate 
Would you recommend this elective to other students? Ye s No
WHY? /WHY NOT?
GENERAL COMMENTS:
PLEASE RETURN COMPLETED FORMS TO:
Undergraduate Medical Education
2124 Medical Sciences Building
1 King's College Circle
Toronto, Ontario M5S 1A8
Fax: (416) 978-4194
medicine.intelective@utoronto.ca