Family and Community Medicine

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Clinical Safari: Student Evaluation Form

 

 

If you were a student on a Clinical Safari, please fill out this evaluation form.  The individual information you provide will be held strictly confidential. Any data will be reported in aggregate form only with any personal identifiers removed.

1.  Your Name (optional): 

2.  Your Position:    

3.  Date you went on Safari:  (___/___/200_) 

4.  Approximate # of hours you spent with your preceptor: (numeric value)

5.  Safari Type:  If other please describe:

6.  What did you learn?

 

- What surprised you?

 

- What was the best thing that happened?

 

- What would you change?

 

7.  How would you rate your preceptor:

(5 = outstanding..........4..........3 = good..........2..........1 = poor)

 

8.  How would you rate the overall Safari Experience:

(5 = outstanding..........4..........3 = good..........2..........1 = poor)

 

9.  Based on this experience, would you go on another Sarari?

(5 = definitely yes..........4..........3 = maybe..........2..........1 = definitely not)

 

Thank you very much!

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Page Updated 12/08/2014