Rush EM Resident Evaluation of Student

Student Information

Students: Please complete this page and then hand your device to the resident to complete the evaluation. Surveys are collated and verified based on name entered. Please enter your name the same way for all shifts.

This evaluation is to be completed by Rush EM Residents to evaluate the student they worked with on shift.

Please note this evaluation is for MEDICAL STUDENTS ONLY. For end of shift evaluations OF residents please reference rushem.org for links to resident end-of-shift evaluations.

Question Title

* 1. Last Name (Student)

Question Title

* 2. First Name (Student)

Question Title

* 3. Shift Date and Time

Please enter the shift start time and the date (on which the shift started for overnight shifts)

Date

Time

AM/PM

Rush EM Resident Evaluation of Student

Student Information

Question Title

* 1. Last Name (Student)

Question Title

* 2. First Name (Student)

Question Title

* 3. Shift Date and Time

Question Title

* 4. Please enter the name of the resident completing the evaluation (Last name, First name)