Please complete the following items by selecting the response that best describes your experience with the preceptor being evaluated. Use the following scale.
1. I enjoyed my preceptorship experience *
- Select - Strongly Disagree Disagree Neutral Agree Strongly Agree
2. I would recommend the program to other students *
- Select - Strongly Disagree Disagree Neutral Agree Strongly Agree
3. I would recommend my preceptor to other students *
- Select - Strongly Disagree Disagree Neutral Agree Strongly Agree
4. My preceptor and I established goals at the outset of the program *
- Select - Strongly Disagree Disagree Neutral Agree Strongly Agree
5. My preceptor gave constructive feedback about my performance during the month *
- Select - Strongly Disagree Disagree Neutral Agree Strongly Agree
6. My preceptor made adequate time for teaching/learning sessions *
- Select - Strongly Disagree Disagree Neutral Agree Strongly Agree
7. My preceptor provided me with the amount of responsibility I thought was appropriate *
- Select - Strongly Disagree Disagree Neutral Agree Strongly Agree
8. My preceptor seemed to enjoy teaching and having me in his/her office *
- Select - Strongly Disagree Disagree Neutral Agree Strongly Agree
9. My preceptor made my position as a medical student clear to the patient *
- Select - Strongly Disagree Disagree Neutral Agree Strongly Agree
10. My preceptor selected appropriate patients for me to interact with. *
- Select - Strongly Disagree Disagree Neutral Agree Strongly Agree
11. I gained useful information about office management procedures and office organization *
- Select - Strongly Disagree Disagree Neutral Agree Strongly Agree
12. I felt comfortable during my preceptor experience *
- Select - Strongly Disagree Disagree Neutral Agree Strongly Agree
13. I gained insight and experience with the community health resources available to my preceptor *
- Select - Strongly Disagree Disagree Neutral Agree Strongly Agree
14. My preceptor demonstrated a good balance of personal and professional life *
- Select - Strongly Disagree Disagree Neutral Agree Strongly Agree
16. As a result of the preceptorship experience, I am more likely to enter pediatrics *
- Select - Strongly Disagree Disagree Neutral Agree Strongly Agree
