Senior Ambulatory Family Medicine Evaluation

Instructions: This evaluation is aimed at eliciting your responses to several aspects of the clerkship. Your responses will be kept confidential and has no bearing on your grade for this course.

Please provide some general information regarding your elective rotation.

Start Date:

Date Date Picker Icon

End Date:

Date Date Picker Icon

Preceptor Name:

Site Name:

Please answer the following questions regarding primary care.

1. Do you plan to apply for residency in primary care?

Yes No

If yes, which primary care area are you applying to for residency?

Family Medicine General Pediatrics General Internal Medicine

2. Do you intend to provide care for underserved populations?

Yes No

3. Do you plan to work in a primary care setting?

Yes No

4. Do you plan to work in rural areas (not big cities)?

Yes No

Please indicate how well you agree with the following statements.

5. The Senior Ambulatory Family Medicine rotation improved my understanding of:

	Strongly Agree	Agree	Disagree	Strongly Disagree	Made No Difference
Overall Patient Care
Cultural Competence in Primary Care
Determinants of Health

6. After this rotation, my interest in practicing in an underserved area:

Increased Decreased Did no change

Listed below are a series of questions relating to the orientation and meaningfulness of your clerkship. Please answer the questions below regarding your experience during this clerkship.

7. How well were your roles and your responsibilities discussed and clarified during your first few days at your rotation site?

Very Adequately Adequately Inadequately

8. Please rate the items below regarding your preceptor.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Communicates effectively with patients
Communicates effectively with students
Takes advantage of teaching opportunities

9. Please indicate how frequently your preceptor made you aware of possible ways of improving your skills and increasing your knowledge.

Once a day Once a week Twice during rotation Once during rotation Never

10. How effective was the rotation in providing your opportunities to exercise your own clinical judgement?

Very effective Effective Somewhat effective Ineffective Very ineffective

11. Were there any social agencies/community resources available to your patients in the community where you completed your rotation? If so, specify the number of times patients referred to those resources?

Yes No

Approximate times patients were referred to community resources.

12. With respect to providing you with meaningful and rich exposure to primary care, this rotation has been:

Very successful Successful Unsuccessful Extremely unsuccessful

13. Rate the value of the course assignments in your overall education.

	Excellent	Good	Fair	Poor
Community Service Project
Reflection Paper

14. In terms of overall satisfaction with your experience, you are:

Very satisfied Satisfied Neutral Disappointed Very disappointed

15. If you have any comments or recommendations, please list them below.