TXACP Preceptor Evaluation of Student
Evaluation for preceptors are a required part of the successful completion of the rotation and survey results are part of the chapter's reporting requirements to ensure longevity of the program
Name
*
First and Last
Email Address
*
Practice Name
*
Phone Number
*
Please enter a valid phone number.
Student Name
*
What date did the preceptorship start?
*
-
Month
-
Day
Year
Date
What date did the preceptorship end?
*
-
Month
-
Day
Year
Date
How many weeks total was the preceptorship?
*
2 Weeks
3 Weeks
4 Weeks
Other
Did the student precept with you for all dates this preceptorship was scheduled for?
*
Yes
No
If no, what dates did the student precept with you?
Did your student behave professionally?
Yes
No
If no, please explain
Was your student on time?
*
Yes
No
Did your student establish goals?
*
Yes
No
Was your student able to perform examinations?
*
Yes
No
Was your students knowledge base and performance satisfactory?
*
Yes
No
Did your student gain a better understanding of internal medicine throughout the preceptorship
*
Yes
No
In what areas did your student progress the most?
*
In which areas would you recommend your student work on?
*
In your opinion, should this student receive academic credit through their medical school if applicable? *Currently academic credit is only offered at UTMB Galveston
*
Yes
No
Please rate your students overall performance
*
Excellent
Very Good
Fair
Poor
Very Poor
What comments do you have about the GIMSPP program
*
How would you rate the experience you had?
*
Excellent
Very Good
Fair
Poor
Very Poor
Will you continue to mentor students through GIMSPP?
*
Yes
No
Would you recommend this program to your colleagues?
*
Yes
No
If no, please explain
Do you have any recommendations for the staff for next year?
*
Please add any additional comments here
Would you allow the above comments/answers to be shared with your student if they request?
Yes
No
This survey is subject for review by the Texas Higher Education Coordinating Board.
I hereby certify that I, the preceptor/physician, am the one who completed this survey
Submit
Questions about this survey? Email Alyssa@aminc.org or call us at 512-285-8953
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