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* 1. Student's Name

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* 2. Preceptor's Name and Certification Level

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* 4. Date of call

Date / Time

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* 9. How would you rate the student on TEAM EFFORT?

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* 10. How would you rate the student on PATIENT INTERACTION?

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* 11. How would you rate the student in their ability to IDENTIFY PATIENT PRIORITIES?

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* 12. Rate the student on maintaining his/her composure during the call.

Was NOT composed. Was VERY composed
i We adjusted the number you entered based on the slider’s scale.

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* 13. How was the student's OVERALL PERFORMANCE on this call?

Performed poorly. Is developing skills appropriately. Perform above expectations.
i We adjusted the number you entered based on the slider’s scale.

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* 14. Please add any further comments.

0 of 14 answered
 

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