Student Evaluation of Rotation

 

Assigned Preceptor:      DROP-DOWN MENUS 1 PER HOSPITAL (Pick or type)

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Rotation Name:             DROP-DOWN MENU (Pick or type)

Type of Rotation:           DROP-DOWN MENU (Assigned Service, Credit Elective, Non-Credit Elective)

 

Date of Rotation:           __ / __ / __ to __ / __ / __       If split Rotation:             __ / __ / __ to __ / __ / __

 

Section 1:  The rotation as a whole.

Please use the scale below to answer the questions about the rotation as a whole.

NA = Not applicable      1=Strongly disagree   2=Disagree   3=Neutral   4=Agree   5=Strongly agree

  1. I was provided an orientation at the beginning of the rotation.                   1    2    3    4    5
  2. Preceptors/instructors were readily accessible to me.                              1    2    3    4    5
  3. I was given clear explanations and directions.                                          1    2    3    4    5
  4. I had adequate opportunities to practice procedures,

charting, prescription writing, etc.                                                           1    2    3    4    5

  1. I was given specific, constructive feedback.                                            1    2    3    4    5
  2. I was given case related reading assignments, videotapes, etc.                 1    2    3    4    5
  3. Preceptors/instructors use “questions” and “student inquiry”

as teaching/learning methods.                                                                 1    2    3    4    5

  1. I was encouraged to accept increasing responsibility with patient

management throughout this rotation.                                                      1    2    3    4    5

  1. Overall, this was an effective clinical rotation.                                         1    2    3    4    5

 

On a scale of 1 – 5,    1 = Almost           2 = Never         3 = Seldom        4 = Often,         5 = Frequently

 

1.       The instructor(s) on this rotation used OMM with his/her patients.                                        1   2    3    4    5

2.       The instructors and I discussed the principles of Osteopathy in our case

3.       discussions of patients.                                                                                                       1    2    3    4    5

4.       The instructors and I discussed appropriate OMM techniques in our case    

5.       discussions of patients.                                                                                                       1    2    3    4    5

6.       I was able to perform OMM on this rotation.                                                                       1    2    3    4    5

7.       The preceptor(s) addressed "quality/patient safety" issues that arose during the rotation.        1    2    3    4    5

8.       The preceptor(s) addressed "cultural competency" issues that arose during the rotation.         1    2    3    4    5

9.       The preceptor(s) addressed "evidence-based medicine" issues that arose during the rotation. 1    2    3    4    5

 

On a scale of 1 – 5,    with 1=“shadowing    and    5=management with preceptor approval

                                                                                                                                                                                               Management with

  1. My involvement in patient management                                       Shadowing                             preceptor approval

at the beginning of this rotation was:                                                       1    2    3    4    5

  1. My involvement in patient management

at the end of this rotation was:                                                                1    2    3    4    5

 

12.   General comments about this rotation/service:

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13.  Type of practice:  DROP-DOWN MENU (Rural, Sm. Community, Urban, Inner City)

 

14. Activities: The average number of hours per day:

I spent in preceptor’s office:                                                       DROP-DOWN MENU (1-15)

I spent in the hospital:                                                                DROP-DOWN MENU (1-15)

I spent in patient contact:                                                           DROP-DOWN MENU (1-15)

I spent in case discussion with preceptor/instructors:                    DROP-DOWN MENU (1-15)

I had available for reading:                                                         DROP-DOWN MENU (1-15)

 

15. Briefly describe you “active participation” on this clinical rotation:

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16. Briefly describe the “preceptor’s expectations” of students on this rotation:

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Section II:  Assigned Preceptors

Approximate % of time spent with the assigned preceptor:                       DROP-DOWN MENU

OPTIONS:  <5,5,10,25,30,50,75,80,90,100

Please answer the following questions about your assigned preceptor. 

1.       Accessible                                                                                \

2.       Provided adequate guidance/direction for my learning      \

3.       Specific, constructive feedback                                        >     1-5 buttons

4.       Allows active involvement in case management               /

5.       Overall effectiveness as clinical teachers                                    /

Text Box: Click for Section IV

Section III:  Interns/Residents

NOTE:  If there were no interns/residents, skip to “Section IV – Other Preceptors” 

Approximate % of time spent with the interns/residents:               DROP-DOWN MENU

OPTIONS:  <5,5,10,25,30,50,75,80,90,100

Please answer the following questions about the interns/residents.

1.       Accessible                                                                                \

2.       Provided adequate guidance/direction for my learning      \

3.       Specific, constructive feedback                                        >     1-5 buttons

4.       Allows active involvement in case management               /

5.       Overall effectiveness as clinical teachers                                    /

 

Text Box: Click for Section V Section IV:  Other Preceptors/Attendings

NOTE:  If there were no other preceptors/attendings, skip to the “Section V”

 

a.   Name of other preceptor/attending:  First__________  Last________________ MD/DO ____

Approximate % of time spent with this clinical teacher:                      DROP-DOWN MENU

OPTIONS:  <5,5,10,25,30,50,75,80,90,100

Please answer the following questions about your assigned preceptor. 

6.       Accessible                                                                                \

7.       Provided adequate guidance/direction for my learning      \

8.       Specific, constructive feedback                                        >     1-5 buttons

9.       Allows active involvement in case management               /

10.   Text Box: Click for Section V Overall effectiveness as clinical teachers                                    /

 

NOTE:  If there are no other preceptors/attendings, skip to the “Section V”  

 

 

Section V:  Comments about the Rotation as a Whole

 

17.  Any other comments about this rotation as a teaching service.

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18.  Any comments about any/all of the preceptors, residents, or interns on this rotation.

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If all is correct, press to submit.