Preceptor Evaluation Form

You're evaluating for their rotation during the period which ran from to . As the Preceptor of record for the medical student under your tutelage, it is necessary that you complete this electronic Evaluation. To aid in your thorough evaluation, you can now review the Procedure Logs and entries made by your student.


View Student Clinical Encounter Logs View Student Procedure Logs

The below performance ratings are designed to evaluate a student engaged in their 3rd year of clinical rotations which corresponds to their first year of full time clinical training.

  • Unacceptable: Performs below the expected standards for the first year of clinical training (OMS3) despite feedback and direction
  • Below Expectations: Performs below expectations for the first year of clinical training (OMS3). Responds to feedback and direction but still requires maximal supervision, and continual prompting and direction to achieve tasks
  • Meets Expectations: Performs at the expected level of training (OMS3); able to perform basic tasks with some prompting and direction
  • Above Expectations: Performs above expectations for their first year of clinical training (OMS3); requires minimal prompting and direction to perform required tasks
  • Exceptional: Performs well above peers; able to model tasks for peers or juniors, or medical students at the OMS3 level

  • Area of Evaluation – Communication
    Question Unacceptable Below Expectations Meets Expectations Above Expectations Exceptional N/A
    1. Effectively listen to patients, family, peers, & healthcare team.

    2. Demonstrates compassion and respect in patient communications.

    3. Effectively collects chief complaint and history.

    4. Considers whole patient: social, spiritual & cultural concerns.

    5. Efficiently prioritizes essential from non-essential information and presents cases in an accurate, concise and well organized manner.

    6. Assures patient understands instructions, consents & medications.

  • Area of Evaluation – Problem Solving
    Question Unacceptable Below Expectations Meets Expectations Above Expectations Exceptional N/A
    1. Identifies important questions and separates data in organized fashion organizing positives and negative.

    2. Discerns major from minor patient problems.

    3. Formulates a differential identifying most common or likely diagnoses.

    4. Identifies indications for & applies findings from the most common radiographic and diagnostic tests.

    5. Identifies correct management plan considering contraindications & interactions.

  • Area of Evaluation – Clinical Skills
    Question Unacceptable Below Expectations Meets Expectations Above Expectations Exceptional N/A
    1. Assesses vital signs & triages patient according to degree of illness.

    2. Performs an appropriate HEENT exam and identifies pertinent findings and abnormalities.

    3. Performs an appropriate cardiopulmonary exam, including auscultation, and identifies pertinent findings and abnormalities.

    4. Performs an appropriate gastrointestinal / abdominal exam, including auscultation and palpation, and identifies pertinent findings and abnormalities.

    5. Performs an appropriate neurologic exam and identifies pertinent findings and abnormalities.

    6. Performs a thorough physical exam pertinent to the patient’s chief complaint.

  • Area of Evaluation – OMM
    Question Unacceptable Below Expectations Meets Expectations Above Expectations Exceptional N/A
    1. Applies osteopathic manipulative medicine successfully when appropriate.

  • Area of Evaluation – Medical Knowledge
    Question Unacceptable Below Expectations Meets Expectations Above Expectations Exceptional N/A
    1. Can identify & correlate anatomy, pathology and pathophysiology related to most disease processes.

    2. Self-motivated learner demonstrating interest and enthusiasm about patient cases.

    3. Thorough & knowledgeable in researching evidence based literature.

    4. Actively seeks feedback from preceptor on areas for improvement.

    5. Correlates patient findings with the most common diagnoses.

    6. Identifies and understands treatments for common presenting diseases and conditions.

  • Area of Evaluation – Professional & Ethical
    Question Unacceptable Below Expectations Meets Expectations Above Expectations Exceptional N/A
    1. Is dutiful, arrives on time, stays until all tasks are complete and follows through on patient care responsibilities.

    2. Accepts feedback and acknowledges errors. Readily responds to feedback, seeks to improve performance and is not resistant to advice.

    3. Assures professionalism in relationships with patients, staff, & peers.

    4. Displays integrity & honesty in medical ability and documentation.

    5. Is well prepared for and seeks to provide high quality patient care.

    6. Identifies the importance to care for underserved populations in a nonjudgmental & altruistic manner.

Preceptor has reviewed the student's patient log entries and approves of the student’s completed clinical skills procedure log for the rotation.



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