Senior Ambulatory Family Medicine Evaluation
Instructions:
This evaluation is aimed at eliciting your responses to several aspects of the clerkship. Your responses will be kept confidential and has no bearing on your grade for this course.
Please provide some general information regarding your elective rotation.
Start Date:
-
Month
-
Day
Year
Date
End Date:
-
Month
-
Day
Year
Date
Preceptor Name:
Site Name:
Please answer the following questions regarding primary care.
1. Do you plan to apply for residency in primary care?
Yes
No
If yes, which primary care area are you applying to for residency?
Family Medicine
General Pediatrics
General Internal Medicine
Other
2. Do you intend to provide care for underserved populations?
Yes
No
3. Do you plan to work in a primary care setting?
Yes
No
4. Do you plan to work in rural areas (not big cities)?
Yes
No
Please indicate how well you agree with the following statements.
5. The Senior Ambulatory Family Medicine rotation improved my understanding of:
Strongly Agree
Agree
Disagree
Strongly Disagree
Made No Difference
Overall Patient Care
Cultural Competence in Primary Care
Determinants of Health
6. After this rotation, my interest in practicing in an underserved area:
Increased
Decreased
Did no change
Listed below are a series of questions relating to the orientation and meaningfulness of your clerkship. Please answer the questions below regarding your experience during this clerkship.
7. How well were your roles and your responsibilities discussed and clarified during your first few days at your rotation site?
Very Adequately
Adequately
Inadequately
8. Please rate the items below regarding your preceptor.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Communicates effectively with patients
Communicates effectively with students
Takes advantage of teaching opportunities
9. Please indicate how frequently your preceptor made you aware of possible ways of improving your skills and increasing your knowledge.
Once a day
Once a week
Twice during rotation
Once during rotation
Never
10. How effective was the rotation in providing your opportunities to exercise your own clinical judgement?
Very effective
Effective
Somewhat effective
Ineffective
Very ineffective
11. Were there any social agencies/community resources available to your patients in the community where you completed your rotation? If so, specify the number of times patients referred to those resources?
Yes
No
Approximate times patients were referred to community resources.
12. With respect to providing you with meaningful and rich exposure to primary care, this rotation has been:
Very successful
Successful
Unsuccessful
Extremely unsuccessful
13. Rate the value of the course assignments in your overall education.
Excellent
Good
Fair
Poor
Community Service Project
Reflection Paper
14. In terms of overall satisfaction with your experience, you are:
Very satisfied
Satisfied
Neutral
Disappointed
Very disappointed
15. If you have any comments or recommendations, please list them below.
Submit
Should be Empty: