Student Intern / Resident Evaluation Request
Enter the clinical / field date
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What's your name (student / resident)?
Where were you?
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.
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.
Should be Empty: