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PRECEPTOR EVALUATION AND LEARNING EXPERIENCE
EVALUATION
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Intern: |
Preceptor: |
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Rotation type:
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Rotation period:
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Part I-Evaluation of the
Preceptor
Please mark one of the
following for each statement concerning the preceptor.
1=Strongly agree 2=Agree 3=Neither
Agree/Disagree
4=Disagree 5=Strongly disagree
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5 |
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1. |
The preceptor was a
pharmacy practice role model. |
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2. |
The preceptor gave
me feedback. |
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3. |
The preceptor’s
feedback helped me improve my performance. |
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4. |
The preceptor was
available when I needed him/her. |
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5. |
When possible, the
preceptor arranged the necessary learning opportunities to meet my
objectives. |
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6. |
The preceptor
displayed enthusiasm for teaching. |
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7. |
The preceptor gave
clear explanations. |
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8. |
The preceptor asked
questions that caused me to do my thinking. |
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9. |
The preceptor
answered my questions clearly. |
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10. |
The preceptor
modeled for me, coached my performance, or facilitated my independent
work as appropriate. |
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11. |
The preceptor
displayed interest in me as an intern. |
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12. |
The preceptor
displayed dedication to teaching. |
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13. |
The preceptor
demonstrated proficient skill in clinical techniques and knowledge. |
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14. |
The preceptor was
accessible in clinic and/or on rounds. |
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15. |
The preceptor
defined and adequately covered the learning objectives during
orientation. |
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16. |
The preceptor
provided adequate assignments to improve my verbal and written
communication skills. |
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17. |
The preceptor
encouraged me to be an active learner. |
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18. |
The preceptor
provided frequent and prompt feedback. |
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19. |
The preceptor
developed opportunities for me to learn within an interdisciplinary
team. |
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20. |
The preceptor
displayed professionalism throughout the rotation. (meeting with interns
as scheduled; manner of interaction with interns during scheduled
meetings; demonstrated decorum at the rotation site). |
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21. |
The preceptor met
with me at least 5 hours per week to discuss my performance and to
provide feedback. |
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Comments |
PART II-EVALUATION OF THE
LEARNING EXPERIENCE
Please mark one of the
following for each statement concerning the preceptor.
1=Strongly agree 2=Agree 3=Neither
Agree/Disagree
4=Disagree 5=Strongly disagree
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1 |
2 |
3 |
4 |
5 |
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1. |
I understood the
objectives for this learning experience prior to beginning. |
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2. |
The learning
objectives afforded me during this learning experience matched the
objectives specified for this experience. |
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3. |
Resources I needed
were available to me.
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4. |
I feel that the
preceptor’s assessment of my performance on the objectives was fair. |
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5. |
I was encouraged to
further develop my ability to self-asses during this learning
experience. |
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6. |
This learning
experience provided me opportunities to provide pharmaceutical care in a
responsible way to my patients. |
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What were the
strengths of this learning experience? |
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What were the
weaknesses of this learning experience? |
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What suggestions can
you make to improve this learning experience? |
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___________________________________________ ___________________
Intern’s Signature
Date
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