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Preceptor Information

Evaluation of Student
  • Please take a few minutes to complete this form.
  • You must click the "Submit Evaluation" button at the bottom when finished.
  • Before submitting, you may want to print a copy for your records.

*Required fields

Date: (i.e., 1/1/2007)


*Student was prompt and professional, respectful of others, appropriately prepared.
Satisfactory      Unsatisfactory

*Student participated actively, demonstrated interest, asked appropriate questions.
Satisfactory     Unsatisfactory

*Student demonstrated independent learning (i.e., returned with answers, indicated intent to learn from experience).
Satisfactory     Unsatisfactory

*Communicated socially with others.
Satisfactory     Unsatisfactory 

*Presented components of the history to you correctly six times this year.
Satisfactory     Unsatisfactory 

If feedback was provided to the student on the history presentation, did the student incorporate the feedback in their future presentations.
Yes     No 

*Had you sign off on skill card six times this year?
Satisfactory     Unsatisfactory 

*Please list an overall student performance evaluation.
Satisfactory     Unsatisfactory     Insufficient

  • Satisfactory - This is the USUAL grade for the preceptorship program. The student has shown ordinary competence expected of a first year medical student.
  • Insufficient - The student has failed to keep in contact with the preceptor, made fewer than three visits, or for other reasons there is no basis for a grade recommendation.
  • Unsatisfactory - The student has shown a performance that is unsatisfactory in that it is substantially below that expected from a first year medical student. Please explain in comments and also please call Sonya Grindley (244-2265)

Evaluation of unsatisfactory must be justified below. Otherwise, please comment on student's strengths.

Also please comment on how this learning experience can be improved in the future.

*What is your opinion on having the student visit 6 times?
Not enough     Just right     Too many

*Would you be willing to also serve as a preceptor next year?
Yes--1 student     Yes--2 students     No

*Would you be willing to serve as an academic advisor for a student next year?
Yes     No 

Before submitting, you may want to print a copy for your records.

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