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ACOFP Preceptorship Program Evaluation

ACOFP Preceptorship Program Evaluation

Student Name (optional):
E-mail:*
School Initials:*
Graduation Year:*
Preceptor:*
Program City:*
Program State:*
Dates of Rotation:* to *
* - indicates a required field.
 
Part I: General Rotation Evaluation
1=strongly disagree; 2=disagree; 3=neutral; 4=agree; 5=strongly agree
 1 23 45 NA
1. The orientation program for this rotation was thorough.
2. Education objectives were clearly explained to me.
3. My clinical duties were clearly explained to me.
4. There was an adequate number of teaching patients.
5. There was a variety of case pathology.
6. My documentation was reviewed and feedback given.
7. I received ongoing feedback in a constructive manner.
8. Teaching at the bedside/exam room was good.
9. This rotation was valuable to my learning experience.
10. I was informed of my performance evaluation.
 
List procedures/special skills you learned or performed while on rotation?
 
Part II: Evaluation of Preceptor
1=unacceptable; 2=below expectations; 3=meets expectations; 4=exceeds expectations; 5=execeptional
 1 23 45 NA
11. Enthusiasm/Support of Preceptor
12. Communication Skills of Preceptor
13. Teaching abilities of Preceptor
14. Preceptor Used Osteopathic Principles & Practices
15. Overall Rating of Preceptor
16. Overall Rating of the Rotation
 
17. What is the expected daily schedule for this rotation?
 
18. Comments to be shared with fellow students (include advice on how to prepare for this rotation - i.e., do's/don'ts, books, etc.):
 
19. Feedback to be shared with Preceptor:
 
20. Did this rotation influence your decision to pursue osteopathic family practice?