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* 1. Please enter your contact information below.

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* 2. Student Name

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* 3. Did your student behave professionally?

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* 4. Was your student on time?

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* 5. Did you and your student establish goals?

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* 6. Did you make reassessments of goals?

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* 7. Was your student able to perform examinations?

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* 8. Was your students knowledge base and performance satisfactory?

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* 9. Did your student gain a better understanding of internal medicine throughout the preceptorship?

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* 10. In what areas did your student progress in most?

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* 11. In which areas would you recommend your student work on?

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* 12. Would your student make a good internist?

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* 13. Do you feel comfortable awarding your student academic credit if applicable?

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* 14. Please rate your students overall performance.

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* 15. What comments do you have about your student?

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* 16. What comments do you have about the GIMSPP program?

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* 17. How would you rate the experience you had?

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* 18. Will you continue to mentor students through GIMSPP?

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* 19. Would you recommend this program to your colleagues?

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* 20. Do you have any recommendations for the staff for next year?

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* 21. Please add any additional comments here.

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* 22. As a thank you for your commitment to be a valued GIMSPP preceptor, you are eligible for one of the below. Please select which you would like.

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* 23. This survey is subject for review by the Texas Higher Education Coordinating board.

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