Student Intern / Resident Evaluation Request
Enter the clinical / field date
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Month
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Day
Year
Date Picker Icon
What's your name (student / resident)?
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Booker
Breeden
Cousins
Dowling
Egan
Firestone
Frederickson
Ganzenko
Hamilton
Henry
Hoffman
King
Leval
Markey
Martin
Mechlin
Obando
Reid
Reitz
Rivas
Romano
Ross
Sartini
Smith
SwederGold
Thibault
Thornton
Turcotte
Where were you?
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Clinical (hospital)
Field (medic, AFRA, chase car, class)
Enter the charge paramedic's email address with whom you worked today
Enter the preceptor's email address with whom you worked today
Your evaluation of the preceptor. Note - preceptor does NOT receive this; your submission is completely anonymous.
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Agree
Disagree
Not Observed
Knowledge: associates pathophysiology with patient condition; helps assess patients; promotes application of classroom knowledge to clinical setting
Communication: professional; conveys ideas clearly; actively listens; non-judgmental
Critical Thinking: follows established policies and procedures; demonstrates effective problem solving skills
Caring: culturally sensitive, ethical, professional
Teaching: expresses interest in preceptor role; enthusiastic about sharing knowledge; able to explain things in simple format
Other: arrived on time; on site the entire assigned period; in uniform; provides a safe environment
Please elaborate on any "Disagree". Your preceptor will NOT read your submission.
Submit
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