This evaluation is not for Community Week students. Please complete the paper copy you received in your information package. Thank you. Personal Information Name * Hospital * Status * - Select -ClerkResident Rotation Date * University * Preceptor * EvaluationScore: 1 = Poor - 5 = Excellent 1. Overall Learning Experience * - Select -12345 Comments 2. Learning Environment - Hospital * - Select -12345 Comments 2. Learning Environment - Office * - Select -12345 Comments 3. My preceptor was available to me so I had the support I needed. * - Select -12345 Comments 4. My rotations objectives were met. * - Select -12345 Comments 5. My preceptor encouraged me to explore my limits safely. * - Select -12345 Comments 6. My preceptor provided regular, meaningful, prompt feedback. * - Select -12345 Comments 7. My preceptor demonstrated respect for me as a learner and as a person. * - Select -12345 Comments 8. My preceptor had the following overall impact on me as a learner. * - Select -12345 Comments 9. Accommodation: * - Select -12345 Comments 11. Community Resources * - Select -12345 Comments 12. Other - Comments/Suggestions To prevent automated spam submissions leave this field empty. What code is in the image? * Enter the characters shown in the image.
