Preceptor Evaluation of Student

For additional information, please contact:
Amy White, Director of TPS Foundation and the General Pediatric Preceptorship Program
401 West 15th Street, Suite 682
Austin, Texas 78701
(512) 370-1519

Date:

Student:

Preceptor:

Please complete the following items by selecting the response that best describes your experience with the student being evaluated. Omit any question that you are unable to evaluate.

1. The student took his/her responsibilities as a medical student seriously:

2. The student arrived on time for the required components of the preceptorship experience:

3. The student expressed and interest in the underlying content material of pediatrics:

4. The student demonstrated an ability to interact courteously and professionally with members of the staff and patients:

5. The student demonstrated the ability to establish rapport with patients:

6. The student demonstrated commitments to patient care:

7. The student asked questions about and expressed some understanding of the nature of pediatrics:

8. The student actively solicited help when he/she needed it:

9. The student seemed to listen to and accept feedback in a constructive manner:

10. The student demonstrated an awareness of the relationship of pediatricians to their community:

11. The student demonstrated an awareness of the appropriate use of community resources available for comprehensive patient care:

12. The student can take a history on the patient that is appropriate for his/her level of training:

13. The student can perform examinations that are appropriate for his/her level of training:

14. The student demonstrated a fund of basic knowledge that is appropriate for his/her level of training:

15. The student achieved a level of overall performance that is satisfactory:

As is the case with many complex educational experiences, evaluation forms often leave significant gaps in the educator's perceptions of the student's performance. Please use the space below to comment on any aspect of the student's performance, whether to point out an area of excellence or need.

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