Clinical Rotation AssessmentI

•
CLINICAL ROTATION ASSESSMENT FORM

j cctJ
STUDENT EVALUATION OF CLINICAL ROTATION
NAME OF A ITTNDING PHYSICIAN/PRECEPTOR: NAME OF STUDENT:
'To.'(\_\f\ '?cu.1 d<>L h"N-LA· kO DP-_N\)f\ ~ F\M I ~£..0!) '-( ·

SCHEDULED CLINICAL ROTATION: I 6we.e...\C.s.
TOTAL WEEKS: STUDENT ID NUMBER:
rr,1.
~ME.R.6, ~t-,.IC..'{
START DATE:
o'l..\IS-
I
2./
I ol--\l 1:1'L \ 2-1.
'" E.~\('.J "' t..
ENDDATE:
l 'R-, \'>in 1-i1
STUDENT SIGNATURE:
nt.
lr -~ J. \), . \0...,u.
(.\
CUNICALSITE:
6'0Mn Ki t,\o A: r~ I C'o lt0 ~e... 'fe.o.t\\irA \m~ ,h-, I,
DIRECTIONS: Upon completion of the c/lrNcal rotation, please fill out the following evaluation of the cllnlcal
rotation based on your overall experience. Return completed form to clinicals@ccu.edu.bz
BELOW EXPECTATIONS MEffi EXPECTATIONS EXCEEDS EXPECTATIONS

EVALUATION CRITERIA
LEARNING ENVIRONMENT
RESPECTFUL ANO WELCOMING OF ST\JDENTS

/
ORGANIZATION
CLINICAL OPPORTUNITIES
QUALITY OF TEACHING
OVERALL EDUCATIONAL VALUE
EVALUATION AND FEEDBACK FROM MD /

AVERAGE NUMBER OF CONTACT HOURS PER WEEK? - -~"~
WOULD VOU RECOMMEND THIS ROTATION TO OTHERS? YES/NO
PLEASE COMMENT ON ANY STRENGTHS OR WEAKNESSES OF THIS ROTATION
PLEASE RETURN THIS FORM BY EMAIL TO: clinicals@ccu.cdu.bz

lccu
NAME OF ATTENDING PHYSICIAN/PRECEPTOR: NAME OF STUDENT:
t,.. --. Nl"""o__\ h:,.-,.,; ilih C>s,e.

SCHEDULED CLINICAL ROTATION: I TOTAL WEEKS:
~ l.'lee.¥!
'TP-1.l..A· l<.Ot:>FIN\) A RAMI \:,_~ t,I)~-
STUDENT ID NUMBER:
PS'! L\.1\ 1',1'\t'I R2_ 1"/"\ l'"lh " t. Cf 1 J.

START DA TE: STUDENT SIGNATURE:
f\1< \,.._L I ~\ 1E:a:r~E~ 1,_, ' \·\t _..._ J Jl. "- • t;")_ .1 _1
CLINICAL SIIT:
G,- .I l.., N~ • • , ~ \ Co\1~- <T'n~, l.1= ~ ~,..;,\-,._ [
DIRECTIONS: Upon completion of the clin'lcal rotation, please fill out the following evaluation of the cllnlcal
rotation based on your overall experience. Return completed form to clinicals@!ccu.edu.bz
BELOW EXPECTATI ONS MEETS EXPECTATIONS EXCEEDS EXPECTATIONS

EVALUATION CRITERIA
LEARNING ENVI RONMENT
RESPECTFU L AND WELCOMING OF STUDENTS
ORGANIZATION
QUALITY OF TEACHING
EVALUATION AND FEEDBACK FROM MD

./
_______l:\ 'Lh""-___
AVERAGE NUMBER OF CONTACT HOURS PER WEEK?
WOULD YOU RECOMMEND THIS ROTATION TO OTHERS? YES/ NO --
PLEASE RETURN THIS FORM BY EMAIL TO: clinicals@cc u.edu. bz


e jccc
NAME OF AmNOING PHYSICIAN/PRECEPTOR: NAME OF STUOENT:
b'I' B()._v-<lo.11 {). s,. \-,..-e..',,..i-"10

1"'1"1---U',· K..Cl\"lf'I NDA 'R J:\M \ Ql::c"t>l:>'-j .
STUDENT ID NUMBER:
l
1' ,1>,!c.l)IF\'lR\ c_c;,. l:n,.1€,Q_¼._ R '> I "" \ '"l-J.rn b C.C.\J ·
START DATE: END'°ATE: STUDENT SIGNATURE:
,:i{il 'L+\ 'L..\ 08 b t, I '2..\ <f. /iz.i J...,J1; CJ , ¼ ~IA.,
CLINICAL SITE: (\
G-,\l-M.-...\(\ Cc,\\Q() ~ 'Ter.r_hi rll \¾:, ~" 1.kl

!Y,c,.l i r \
DIRECTIONS: Upon completion of the cllnf2al rotation, please fl/I out the following evaluation of the cllnlca/
BELOW EXPECTATIONS MEETS EXPECTATIONS EXCHDS EXPECTATIONS

EVALUATION CRITERIA
/
RESPECTFUL AND WELCOMING OF STUDENTS
ORGANIZATION
QUALITY OF TEACHING

./
AVERAGE NUMBER OF CONTACT HOURS PER WEEKI _____':L~i,....., --
./
WOULD YOU RECOMMEND THIS ROTATION TO OTHERS? YES/NO
PLEASE RETURN THJS FORM BY EMAIL TO: clinicals@ccu.edu.bz

j cc1:1
NAME OF AffiNOING PHYSICIAN/PRECEPTOR: NAME OF STUDENT:

t,--. · c.,n~\"\d'{) Kc,_ \)c:,_,,d it· '11'-P.P.' J(t,\)f'\1--1.\°:,,'f', 'R.P-~1 ~s;;_~o'i,
SCHEDULED CLINICAL ROTATTON: I TOTAL WEEKS: STUDENT ID NUMBER:
obs.t--ce c.>ci's "'"d l:ri~no.e(o\CA'-1 · o\J.!l1e"' b R l- 1o " 1 +l-1 r-, 1, r r , ,.
START DATE:
1:1 il t> 'l? \ 2..,\ IEN: ;, ~~ I
STUDENT SIGNATURE:
'I•v~..l _t\, D-- _, Ii),, .u
.
CLINICAL SITE:
~ - .,.._...l-'f-..1' 1'1\<>...l,1 ,~\ fo\\ -OCH' \ P~• \-,nil ~~f)i ,h_ \.
DIRECTIONS: Upon completion of the cllnlcar rotation, please fill out the following evaluation of the clinical
BELOW EXPECTATIONS MEETS EXPECTATIONS EXCEEDS EXPECTATIONS

EVALUATION CRITERIA
./
ORGANIZATION
QUALITY OF TEACHING
AVERAGE NUMBER OF CONTACT HOURS PER WEEK? !::J'2....l-i~
PLEASE RETURN THIS FORM BY EMAIL TO: clinicals@ccu.edu.bz

8 lccv

1:)-.-. heh S.lw~"°'\}.,, Tp,./...LA, Kt>l)R~t>A l<JS,M\ Rt:DI) 'j,
SCHEDULED CLINICAL ROTATION:
t\R,~ \'£.I'>\<'.'-,
I TOTAL WEEKS:
~ ~e_\<,.s,.
STUDENT ID NUMBER: .lj
START DATE:
oq\ I'\\ "2...\
I to\ 1f"!'.l...l,
END DATE:
"'-'- 11'/o 1":flob
STUDENT SIGNATURE:
_,-1,~ J I\)
j , \cl.,.U
CLINICAL SITE:
0
&"""rl~\,.: fl\~J : ' " ' (.',I\=" 'fP,-.c¼,"'ll\ \.\:i<:..o/1...t
DIRECTIONS: Upon complet1"em of the clinTcal rotation, please fill out the following evaluation of the clinical
BELOW EXPECTATIONS MEETS EXPECTATIONS

EVALUATION CRITERIA EXCEEDS EXPECTATIONS
./
ORGANIZATION
./
QUALITY OF TEACHIN G

v
AVERAGE NUMBER OF CONTACT HOURS PER WEEKI ········~ h0,______ -----------------------

WOULD YOU RECOMMEND THIS ROTATION TO OTHERS?
v
YES/ NO ----
PLEASE RETURN TIDS FORM BY EMAIL TO: clinicals@ccu.edu.bz

leer
NAME OF ATTENDING PHYSICIAN/PRECEPTOR:
NAM£ OF STUDENT:
D-r- Tu r-1 ~':.\o.. &,1-x"-112. . 'fl'\1-LA · \(t,\:) l'\1'\t> f:1 IJJ'IM I
SCHEDULED CllNICAL ROTA TfDN:
l'\M !o<;,.T\\£<;.11:> l-ol,,~ .
I TOTAL WEEKS:
'1,NQ.e.. I'-!
STUDENT ID NUMBER:
0.£.t>I) 'I·
START DATE:
IO\l,- \ '21
I E'NODATE:
"-'L 1'2Cl \"\- 1-\i::, ~ C...t.\.J•
STUDENT SIGNATURE:
11\11..l 2-1 . '1. JQ, J'--',I , [) . \),, .!,I ,
CllNICAL SITE:
<l
Gto.vvkl • ~~o ..J1 ,~I ('..._IIPo, e
'feru \,\"'" fw. i ni I
DIRECTIONS: Upon completion of the clln7cal rotation, please fill out the following evaluation of the clinical
rotation based an your overall experience. Return completed form to clinicals@ccu.edu .bz
EVALUATION CRITERIA BELOW EXPEtTATIONS MEETS EXPECTATIONS EXaEos EXPECTATIONS

RESPECTFUL ANO WELCOMING OF STUDENTS
ORGANIZATION
QUALITY OF TEACHING
EVALUATION AND FEEDBACK FROM MO
AVERAGE NUMBER OF CONTACT HOURS PER WEEK? 'ahT\ --

YES/NO


eI C'C l T
D"f. ICc.s:.. n ~I:, SI-\~""°'· 'f°l'\l-1-(-'\· KOpP,.t--.\DA QAl"\1 Q\':.~O'j ,

~,wttl<-
STUDENT ID NUMBER:
R "}. \.l.'o 1;1... ~1.. rr11 .
R, P\l)li)l,-0 \,,,\./,
START DATE:
II l II-\ J 'L\
I
END DATE:
t'l..\ 10l 2..1 .
STUDENT SIGNATURE:
T. IC.O J ..I~ D- '. \?. U ....
<l
CLINICAL SITE:
Gu,,"',i~~ f'l\ed,r~\ lo\1.o~ " 'T, ." 1.· ,,," 1~•"'11-n l-
DIRECTIONS: Upon completion of the c/in'lcal rotation, please fill out the fol/owing evaluation of the clinical
BELOW EXPECTATIONS MEETS EXPECTATIONS EXaED5 EXPECTATIONS

EVALUATION CRITERIA
./
ORGANIZATION
QUALITY OF TEACHING
AVERAGE NUMBER OF CONTACT HOURS PER WEEK? _ __140J1.u __
WOULD YOU RECOMMEND THIS ROTATION TD OTHERS? YES/NO
PLEASE RETURN TffiS FORM BY EMAIL TO: clinicals@ccu.edu.bz


e l ccc
~"' S'c..-ci +o.. Tlll().6"'0-h

r-...'l •
I TOTAL WEEKS:
I, wee.lCJ
T r,,-_\..L\'\• Ko ~ l'->.•~fl ll.A t~ I !U,.Cb'-1 ·
STUDENT ID NUMBER:
I\ 'l.. 19.o
() f>T\IF\Lt'-'lr, l r, \+!-. () ~ ((.\),
START DATE: I
END DATE: STUDENT SIGNATURE:
1'2J 1'2..\ '.l.. l , 11-h. 2.. --n1<,__,,J \),_\ \2., ,.\ cl
CLINICAL SITE: <..J
IC'~, ..\ ,~'rJ MP~/tn\ (',, \\ Ca o '\.o ., t,,;,.._t\ U,o "\1-,_ '
DIRECTIONS: Upon completibn of the clin,cal rotation, please fill out the following evaluation of the clinical
rotation based an yaur overall experience. Return completed form to clinicals@ccu.edu.bz
BELOW EXPECTATIONS MEITT EXPECTATIONS

EVALUATION CRITERIA EXCHDS EXPECTATIONS
ORGANIZATION
QUALITY OF TEACHING
EVALUATION ANO FEEDBACK FROM MO
AVERAGE NUMBER OF CONTACT HOURS PER WEEKl ___1--j_~_

l ccc
-
I))· \:s-ri h o. ,; p o-+.; ~lc_\d~t Th i-LA \'..vDAI--ID t'-\ R. P-r---" I 12.~r.,0 '1-
F NT-
I 1-\we~R
'ls'"L ,io 1-:i lll o6
1-j
l!.(. U ·
START DATE:
I I I '2--'L IEND;,:\1-'L STUDENT SIGNATURE:
<[' l,,. J ,.J 0--J Q,,.Jc{, ,
0
CLINICAL SITE:
G..,,,_J_\/ • 'f'\P.111 " \ f:. I\M• T,o~, k,no U...,,,,; 1-r-. \,
DIRECTIONS: Upon complet/iJ n of the clmical rotation, please fill out the following evaluation of the cl/nlcal
rotation based on your overall experience. Return completed form to clinicals@ccu.edu,bz
EVALUATION CRITERIA BELOW EXPECTATIONS MEETS EXPECTATIONS cxaeos EXPECTATIONS

ORGANIZATION
QUALITY OF TEACHING
AVERAGE NUMBER OF CONTACT HOURS PER WEEK? /i 'l.h ~

leer
t)'<'- ~0..=\J.-U)..-\+,,, 1'\Q.\Jf)O.>\le. ~ . kn\:>P> MC~ Rf.>.M I 1<£.t>l)L\,

SCHEDULED CLINICAL ROTATION: I
8.L I tl1 t, (, c,c_u
I
f\ E R. NC\ l"'n '-nGn-1, l1 ~ e_\C.l, 1i:zc:i
START DATE: END DATE: STUDENT SIGNATURE:
0"7 1"-<,,,LL_ \). Q, u
CLINICAL SITE:
u
G-.~ . L \'. : , Ae~\i r - \ r,,,,.,.,p 'fp~A-1~
l.lr-'.t>\ h--1
DIRECTIONS: Upon completlon'of the clinical rotation, please fill out the following evaluation of the clinical
BELOW EXPECTATIONS MEm EXPECTATIONS OlaE.DS EXPECTATIONS

EVALUATION CRITERIA
ORGANIZATION
v
QUALITY OF TEACHING
AVERAGE NUMBER OF CONTACT HOURS PER WEEK? 6 '2...iw'. ..
PLEASE RETURN THIS FORM BY EMAIL TO : clinicals@ccu.edu.bz

•
CLINICAL ROTA TION ASSESSMENT FORM
lcct~ -
NAME OF ATTENDING PHYSICIAN/PRECEPTOR· NAME OF STUDENT:

T: . ..-,~µ_.J'.)• )( of)P.'1-\Pf.:\ QJ>...'"'11 12..t-t>D~.
l'<'-l~n ~ \ Vpo..el\,;'\tl':.\~
y.
SCHEDULED CLINICAL ROTATION :
'J:'N'ft:D\.J~l '!'IW' l)\('1..,_1 "::: ,
I
TOTAL WEEKS:
\'LW'f:.\
STUDENT ID NUMBER:
ll'c_ It o \ "',-J...t·-1, (_('IJ
START DATE: c STUDENT SIGNATURE:

0~ \ I ENDDATE: <,- )t...,J....rl, \) _ .. ' 'f),
rl ~/ 2.'2-
L.t.
o(, ~ 12_. (J
CLINICAL SITE:
G_("\, . L'c:_1 1'\<i.11, .... \ r~,1~- - ~...,1.,"'~ 1..lc"',fn\ I attonofthecllnfcal
DIRECTIONS: Upon completion of the clln~ al rotation, please /Ill out th e following eva u
t t' b r icals@ccu.edu.bz
ro a ion ased on your overall experience. Return completed form to c in
aaEDS EXPECTATIONS
MEETS EXPECTATIONS
BELOW EXPECTATIONS
EVALUATION CRITERIA
RESPECTFUL AND WELCOMING OF STUDENTS /

ORGANIZATION
QUALITY OF TEACHING
AVERAGE NUMBER OF CONTACT HOURS PER WEEK? -
WOULD YOU RECOMMEND THIS ROTATION TO OTHERS? YES/NO -------

•
jcct.J
NAME OF ATTENDING PHYSIC/AN/PRECEPTOR: NAME OF STUDENT:

'TALL-A· ):'.l:l~fl-,..l~r:\ 112,p,r-1 \ \2.t.DDL\
D'l" lsho} R.n._, "'\ e.u.p
SuR&&.R'-1
O..IA.~
I TOTAL WEEKS:
\'2..l.J.)Ee_~
STUDENT ID NUMBER:
R "L 18 0 I ':/--J,, ~b r .r 11
START DATE:
DC-( 2-0 l 'l..'L I
END;y~~ I
STUDENT SIGNATURE:
k. ----1 ..J O_ ...,.: 0 ,, H,a
CLINICAL SITE:
l"ln rL V"' f,'\..,,-1;~ .. \ G::i\\o "" '\fr..r l-:.,,._ l..\r,tr:1h..l
DIRECTION~ Upon completio~ of the cllnictil rotdtion, please fill out the fallowing evaluation of the cllnlcal
rotation based on your overall experience. Return completed form to clin icals@ccu.edu.bz
MEETS EXPECTATIONS EXCEEDS EXPECTATIONS

BELOW EXPECTATIONS
EVALUATION CRITERIA
ORGANIZATION
QUALITY OF TEACHING /
OVERALL EDUCATIONAL VALUE /

______b_e I'\¥\___ ---------------------
/
WOULD YOU RECOMMEND THIS ROTATION TO OTHERS? YES/NO -------------------- ---------------

NAME OF ATTENDING PHYSICIAN/PRECEPTOR:

NAME OF STUDENT:
• jccu
~ 'r. ~ \ Cl.\-\ S.\-\Nlr<\t\ . 'TAL--l--A • l~D At-,.IDA \ll"-t-'1.1 P-'2.t>DY·

1\\1=: 1 ,on, n f-,..,L/ ,
I TOTAL WEEKS: STUDENT 10 NUMBER:
BL 18 0 I 1-t-.,-,h CCJJ
START DATE:
l":l- f to I 'La 'l.\
I ENOOATE:
.l--1 \,l.l ~o b
\'L\11\-2.. I
STUDENT SIGNATURE:
'f- l/" J ,J _0 . , (2,, J~.
CLINICAL SITE:
~F- , A/ f.\ C1 P 1 \-1-Q<::.Plir.:lt
DIRECTIONS: Upon completion of the clinical rotation, please fill out the fol/owing evaluation of the clinical
MEETS EXPECTATIONS £XC£EDS EXPECTATIONS

BELOW EXPECTATIONS
EVALUATION CRITERIA
ORGANIZATION
QUALITY OF TEACHING
AVERAGE NUMBER OF CONTACT HOURS PER WEEK? .... '1!_:i hn ........
WOULD YOU RECOMMEND THIS ROTATION TO OTHERS? YES/ NO ..

NA
ME OF ATTENDING PHYSICIAN/PRECEPTOR:
• /ccu
by, R~~~d"m.. NAME OF STUDENT:

~~+-ht)..
F .F\f>t I LLf
START DATE:
Mf2...D\C~ ~E . ITOTAL WEEKS:
OW~\(!
TAW-A-
l,DO~~r,\ RAM t
STUDENT ID NUMBER:
_I ENDDATE: 'R2 Lffo I +ht\~ Cc 0

lbfti~\
CLINICAL SITE:
2-.r /a l:il 'U:>9-1 STUDENT SIGNATURE:
"f-' k,~l _J h ¼ '-- '. _'!4_c\c-l_l,t

E.__,,N C.,1T"1 \¾)~ Y' IJ°J\L <.,I
DIRECTIONS: Upon comp/et/on of the clinical rotation, please fl// out the fol/owing evaluation of the c/ln/ca/
EVALUATION CRITERIA BELOW EXPECTATIONS

LEARNING ENVIRONMENT MEETS EXPECTATIONS
EXCEEDS EXPECTATIONS
ORGANIZATION
CLINICAL OPPORTUNITIES ./
QUALITY OF TEACHING

_______ci_ G-h_-a___
---------------
YES/NO -------------------------- -------------------

Clinical Rotation AssessmentI

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Clinical Rotation AssessmentI

Uploaded by

Copyright:

Available Formats

•

CLINICAL ROTATION ASSESSMENT FORM

NAME OF A ITTNDING PHYSICIAN/PRECEPTOR: NAME OF STUDENT:

'To.'(\_\f\ '?cu.1 d<>L h"N-LA· kO DP-_N\)f\ ~ F\M I ~£..0!) '-( ·

BELOW EXPECTATIONS MEffi EXPECTATIONS EXCEEDS EXPECTATIONS

RESPECTFUL ANO WELCOMING OF ST\JDENTS

OVERALL EDUCATIONAL VALUE

EVALUATION AND FEEDBACK FROM MD /

PLEASE COMMENT ON ANY STRENGTHS OR WEAKNESSES OF THIS ROTATION

PLEASE RETURN THIS FORM BY EMAIL TO: clinicals@ccu.cdu.bz

NAME OF ATTENDING PHYSICIAN/PRECEPTOR: NAME OF STUDENT:

t,.. --. Nl"""o__\ h:,.-,.,; ilih C>s,e.

PS'! L\.1\ 1',1'\t'I R2_ 1"/"\ l'"lh " t. Cf 1 J.

BELOW EXPECTATI ONS MEETS EXPECTATIONS EXCEEDS EXPECTATIONS

RESPECTFU L AND WELCOMING OF STUDENTS

OVERALL EDUCATIONAL VALUE

EVALUATION AND FEEDBACK FROM MD

WOULD YOU RECOMMEND THIS ROTATION TO OTHERS? YES/ NO --

PLEASE COMMENT ON ANY STRENGTHS OR WEAKNESSES OF THIS ROTATION

PLEASE RETURN THIS FORM BY EMAIL TO: clinicals@cc u.edu. bz

STUDENT EVALUATION OF CLINICAL ROTATION

NAME OF AmNOING PHYSICIAN/PRECEPTOR: NAME OF STUOENT:

b'I' B()._v-<lo.11 {). s,. \-,..-e..',,..i-"10

G-,\l-M.-...\(\ Cc,\\Q() ~ 'Ter.r_hi rll \¾:, ~" 1.kl

BELOW EXPECTATIONS MEETS EXPECTATIONS EXCHDS EXPECTATIONS

OVERALL EDUCATIONAL VALUE

EVALUATION AND FEEDBACK FROM MD

PLEASE COMMENT ON ANY STRENGTHS OR WEAKNESSES OF THIS ROTATION

PLEASE RETURN THJS FORM BY EMAIL TO: clinicals@ccu.edu.bz

STUDENT EVALUATION OF CLINICAL ROTATION

NAME OF AffiNOING PHYSICIAN/PRECEPTOR: NAME OF STUDENT:

BELOW EXPECTATIONS MEETS EXPECTATIONS EXCEEDS EXPECTATIONS

OVERALL EDUCATIONAL VALUE

EVALUATION AND FEEDBACK FROM MD

AVERAGE NUMBER OF CONTACT HOURS PER WEEK? !::J'2....l-i~

WOULD YOU RECOMMEND THIS ROTATION TO OTHERS? YES/NO

PLEASE COMMENT ON ANY STRENGTHS OR WEAKNESSES OF THIS ROTATION

PLEASE RETURN THIS FORM BY EMAIL TO: clinicals@ccu.edu.bz

NAME OF ATTENDING PHYSICIAN/PRECEPTOR: NAME OF STUDENT:

BELOW EXPECTATIONS MEETS EXPECTATIONS

OVERALL EDUCATIONAL VALUE

AVERAGE NUMBER OF CONTACT HOURS PER WEEKI ········~ h0,______ -----------------------

PLEASE COMMENT ON ANY STRENGTHS OR WEAKNESSES OF THIS ROTATION

PLEASE RETURN TIDS FORM BY EMAIL TO: clinicals@ccu.edu.bz

EVALUATION CRITERIA BELOW EXPEtTATIONS MEETS EXPECTATIONS EXaEos EXPECTATIONS

RESPECTFUL ANO WELCOMING OF STUDENTS

OVERALL EDUCATIONAL VALUE

EVALUATION AND FEEDBACK FROM MO

AVERAGE NUMBER OF CONTACT HOURS PER WEEK? 'ahT\ --

PLEASE COMMENT ON ANY STRENGTHS OR WEAKNESSES OF THIS ROTATION

PLEASE RETURN THIS FORM BY EMAIL TO: clinicals@ccu.edu.bz

STUDENT EVALUATION OF CLINICAL ROTATION

NAME OF ATTENDING PHYSICIAN/PRECEPTOR: NAME OF STUDENT:

D"f. ICc.s:.. n ~I:, SI-\~""°'· 'f°l'\l-1-(-'\· KOpP,.t--.\DA QAl"\1 Q\':.~O'j ,

SCHEDULED CLINICAL ROTATION: I TOTAL WEEKS:

BELOW EXPECTATIONS MEETS EXPECTATIONS EXaED5 EXPECTATIONS

OVERALL EDUCATIONAL VALUE

EVALUATION AND FEEDBACK FROM MD

AVERAGE NUMBER OF CONTACT HOURS PER WEEK? _ __140J1.u __

WOULD YOU RECOMMEND THIS ROTATION TD OTHERS? YES/NO

PLEASE COMMENT ON ANY STRENGTHS OR WEAKNESSES OF THIS ROTATION

PLEASE RETURN TffiS FORM BY EMAIL TO: clinicals@ccu.edu.bz

STUDENT EVALUATION OF CLINICAL ROTATION

NAME OF ATTENDING PHYSICIAN/PRECEPTOR: NAME OF STUDENT:

AVERAGE NUMBER OF CONTACT HOURS PER WEEK? _ 140J1.u