Student Feedback Survey

Please take a few minutes to complete this brief survey. Southlake will use your feedback to further develop it's student placement experience. All responses are anonymous and only aggregated data will be shared with preceptors/acedemic partners/Southlake leadership. Thank you!

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* 1. Your school:

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* 2. Your discipline of study:

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* 3. Date range of your placement:

Start Date

Date

End Date

Date

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* 4. Year in program:

1st

2nd

3rd

4th

Graduate Studies

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* 5. Semester:

Fall

Winter

Spring/Summer

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* 6. Please rate the following based on your clinical setting experience:

	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree	N/A
I felt welcomed at Southlake	I felt welcomed at Southlake Strongly Agree	I felt welcomed at Southlake Agree	I felt welcomed at Southlake Undecided	I felt welcomed at Southlake Disagree	I felt welcomed at Southlake Strongly Disagree	I felt welcomed at Southlake N/A
The staff members in the department (or assigned mentor) were approachable	The staff members in the department (or assigned mentor) were approachable Strongly Agree	The staff members in the department (or assigned mentor) were approachable Agree	The staff members in the department (or assigned mentor) were approachable Undecided	The staff members in the department (or assigned mentor) were approachable Disagree	The staff members in the department (or assigned mentor) were approachable Strongly Disagree	The staff members in the department (or assigned mentor) were approachable N/A
The staff on the unit contributed to my learning	The staff on the unit contributed to my learning Strongly Agree	The staff on the unit contributed to my learning Agree	The staff on the unit contributed to my learning Undecided	The staff on the unit contributed to my learning Disagree	The staff on the unit contributed to my learning Strongly Disagree	The staff on the unit contributed to my learning N/A
I had opportunity to attend formal education programs (i,e, inservices, rounds)	I had opportunity to attend formal education programs (i,e, inservices, rounds) Strongly Agree	I had opportunity to attend formal education programs (i,e, inservices, rounds) Agree	I had opportunity to attend formal education programs (i,e, inservices, rounds) Undecided	I had opportunity to attend formal education programs (i,e, inservices, rounds) Disagree	I had opportunity to attend formal education programs (i,e, inservices, rounds) Strongly Disagree	I had opportunity to attend formal education programs (i,e, inservices, rounds) N/A
The patient population/learning focus was appropriate to my knowledge and learning objectives	The patient population/learning focus was appropriate to my knowledge and learning objectives Strongly Agree	The patient population/learning focus was appropriate to my knowledge and learning objectives Agree	The patient population/learning focus was appropriate to my knowledge and learning objectives Undecided	The patient population/learning focus was appropriate to my knowledge and learning objectives Disagree	The patient population/learning focus was appropriate to my knowledge and learning objectives Strongly Disagree	The patient population/learning focus was appropriate to my knowledge and learning objectives N/A
The experience provided me with opportunities to learn new skills and enhance existing skills	The experience provided me with opportunities to learn new skills and enhance existing skills Strongly Agree	The experience provided me with opportunities to learn new skills and enhance existing skills Agree	The experience provided me with opportunities to learn new skills and enhance existing skills Undecided	The experience provided me with opportunities to learn new skills and enhance existing skills Disagree	The experience provided me with opportunities to learn new skills and enhance existing skills Strongly Disagree	The experience provided me with opportunities to learn new skills and enhance existing skills N/A
The experience provided me with an opportunity to gain new knowledge and enhance existing knowledge	The experience provided me with an opportunity to gain new knowledge and enhance existing knowledge Strongly Agree	The experience provided me with an opportunity to gain new knowledge and enhance existing knowledge Agree	The experience provided me with an opportunity to gain new knowledge and enhance existing knowledge Undecided	The experience provided me with an opportunity to gain new knowledge and enhance existing knowledge Disagree	The experience provided me with an opportunity to gain new knowledge and enhance existing knowledge Strongly Disagree	The experience provided me with an opportunity to gain new knowledge and enhance existing knowledge N/A
The climate in the department provided learning	The climate in the department provided learning Strongly Agree	The climate in the department provided learning Agree	The climate in the department provided learning Undecided	The climate in the department provided learning Disagree	The climate in the department provided learning Strongly Disagree	The climate in the department provided learning N/A
I had the opportunity to participate in the interprofessional learning experience	I had the opportunity to participate in the interprofessional learning experience Strongly Agree	I had the opportunity to participate in the interprofessional learning experience Agree	I had the opportunity to participate in the interprofessional learning experience Undecided	I had the opportunity to participate in the interprofessional learning experience Disagree	I had the opportunity to participate in the interprofessional learning experience Strongly Disagree	I had the opportunity to participate in the interprofessional learning experience N/A
When I graduate I would like to work at Southlake Regional Health Centre	When I graduate I would like to work at Southlake Regional Health Centre Strongly Agree	When I graduate I would like to work at Southlake Regional Health Centre Agree	When I graduate I would like to work at Southlake Regional Health Centre Undecided	When I graduate I would like to work at Southlake Regional Health Centre Disagree	When I graduate I would like to work at Southlake Regional Health Centre Strongly Disagree	When I graduate I would like to work at Southlake Regional Health Centre N/A

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* 7. Suggested topics for student orientation:

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* 8. Suggested topics for inservice education sessions:

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* 9. The highlight of this experience was:

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* 10. What most impressed me about Southlake Regional Health Centre was:

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* 11. To improve the clinical experience, I would recommend:

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* 12. To improve the student experience, I would recommend:

Thank you for your feedback. If you would like to discuss your comments further, please contact Susan King, Professional Practice Lead, Student Placements at ext. 2872 (scking@southlakeregional.org), or Carol Williams, Manager of Professional Practice at ext. 2954 (cwilliams@southlaeregional.org).