JUNIOR inpatient Internal Medicine CLERKSHIP EVALUATION

3 January to 30 january  2005

Site:__________________________

      (UniMed, VAMC, Privates, Immanuel, St. Mary’s)  

Rating scale:  1 (strongly disagree) through 5(strongly agree)

1

2

3

4

5

Patient variety was appropriate

 

 

 

 

 

Night call was a valuable learning experience

 

 

 

 

 

Comments

 

Rating scale:  1 (too few) through 3 (just right) through 5 (too many)

1

2

3

4

5

Patient load (numbers)

 

 

 

 

 

Number of night calls

 

 

 

 

 

Comments

 

Morning Report

Rating scale:  1 (strongly disagree) through 5(strongly agree)

1

2

3

4

5

Morning report improved my presentation skills

 

 

 

 

 

Comments

 

Faculty Evaluation:       Name:

Rating scale:  1 (strongly disagree) through 5(strongly agree)

1

2

3

4

5

Provided me with effective feedback on my performance

 

 

 

 

 

Created an effective learning climate

 

 

 

 

 

Showed interest and enthusiasm in teaching

 

 

 

 

 

Showed me respect and listened to my opinions

 

 

 

 

 

Encouraged me to learn on my own

 

 

 

 

 

Encouraged me to actively participate in patient care

 

 

 

 

 

 

Rating scale:  1 (poor), 2 (fair), 3 (average), 4 (above average), 5 (superior)

1

2

3

4

5

Rate this faculty’s overall clinical teaching skills

 

 

 

 

 

Comments

 

Housestaff Evaluation:  HO-I: 

Rating scale:  1 (strongly disagree) through 5(strongly agree)

1

2

3

4

5

Provided me with effective feedback on my performance

 

 

 

 

 

Created an effective learning climate

 

 

 

 

 

Showed interest and enthusiasm in the subject

 

 

 

 

 

Showed me respect and listened to my opinions

 

 

 

 

 

Encouraged me to learn on my own

 

 

 

 

 

Encouraged me to actively participate in patient care

 

 

 

 

 

Comments

 

 Housestaff Evaluation:  HO-2 or 3:

Rating scale:  1 (strongly disagree) through 5(strongly agree)

1

2

3

4

5

Provided me with effective feedback on my performance

 

 

 

 

 

Created an effective learning climate

 

 

 

 

 

Showed interest and enthusiasm in the subject

 

 

 

 

 

Showed me respect and listened to my opinions

 

 

 

 

 

Encouraged me to learn on my own

 

 

 

 

 

Encouraged me to actively participate in patient care

 

 

 

 

 

Comments

 

Jeopardy Sessions:

Rating scale:  1 (strongly disagree) through 5(strongly agree)

1

2

3

4

5

Was a stimulus to read and study further

 

 

 

 

 

Assisted me in preparation for the exam

 

 

 

 

 

Comments

 

Didactic Lectures – Chief Resident  Dr. Barry

Rating scale:  1 (strongly disagree) through 5(strongly agree)

1

2

3

4

5

Encouraged learner participation

 

 

 

 

 

Stated goals and objectives of the lecture clearly and concisely

 

 

 

 

 

Presented well-organized material

 

 

 

 

 

Effectively used visual aides

 

 

 

 

 

Was knowledgeable and familiar with the lecture material

 

 

 

 

 

Comments

 

Didactic Lectures – Chief Resident Dr. Jurrens

Rating scale:  1 (strongly disagree) through 5(strongly agree)

1

2

3

4

5

Encouraged learner participation

 

 

 

 

 

Stated goals and objectives of the lecture clearly and concisely

 

 

 

 

 

Presented well-organized material

 

 

 

 

 

Effectively used visual aides