Preceptor Evaluation of PA Student
|Rotation No. (1-9)||____________________|
|Preceptor’s Name and Title||____________________|
|Medical Discipline Completed||____________________|
|Supervising Physician (as identified by PA Studies Program)||____________________|
|Date of Rotation||____________________|
Please assess the PA student in each of the categories listed below by rating the student’s performance:
4= Exceeds expectations 3= Meets expectations 1= Does not meet expectations N/A= Not observed or not applicable
|A. Medical interview||A.||1. Relating to Colleagues||1.|
|B. Physical examination||B.||2. Relating to Patients||2.|
|C. Oral case presentation||C.||3. Understanding of PA role and recognition of limitations||3.|
|D. Written patient record||D.||4. Self-confidence||4.|
|E. Appropriate laboratory tests knowledge & utilization||E.||5. Reliability, Dependability & attendance||5.|
|F. Clinical procedures||F.||6. Professionalism||6.|
|G. Clinical reasoning and problem|
|H. Factual knowledge & concepts||H.||8. Appearance||8.|
|I. Assessment and differential|
|J. Ability to form and implement a|
|J.||Number of Absences||__|
Do you have any reservations about the clinical competency of this student?
Do you have reservations about the professional behavior of this student?
Do you desire a phone call from a clinical coordinator regarding this student?
Preceptor’s signature Date
Student’s signature after review ________ _ Date ___
FAX: 843-792-9172 or 792-0506 E-mail: email@example.com Phone: 843-792-1913
Mail: PA Division (B-103), 151-B Rutledge Ave. (MSC 962), Charleston, SC, 29425.