1.

Please rate your performance as a preceptor based on the following measures.  Feel free to add comments in the blank text boxes provided. It would be helpful to hear specifics about the ways in which you're achieving success so that we can celebrate and garner wisdom from your accomplishments. Knowing about your struggles will also inform our ability to offer more targeted support to you in the areas where you are facing challenges.

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* 1. Preceptor Name

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* 2. Student Name (if you have more than one student, please fill out a separate form for each student)

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* 3. Date

Date

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* 5. I clearly identify and communicate to my student the learning outcomes expected from her.

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* 6. I identify my student's learning style and have a strategy to match it.

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* 7. I give briefings, debriefings and feedback to help my student succeed academically and achieve mastery of clinical skills.

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* 8. I implement meaningful formative assessments for my student.

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* 9. I implement well crafted summative assessments for my student.

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* 10. I have been able to help maximize student's talents and I have been able to help student with obstacles to learning.

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* 11. I identify and address issues/disagreements with my student. I take the time to discuss the Student-Preceptor Evaluation results with my student each trimester, take needed actions based on these evaluations, and ask for help from my community and/or NCM staff when issues arise that I am unable to address myself.

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* 12. I have appropriately addressed any FORMAL complaints or grievances filed through NCM.  (PLEASE NOTE:  This ONLY applies to FORMAL COMPLAINTS or GRIEVANCES that have gone through NCM's FORMAL PROCESS.  This does not apply to complaints or grievances that have been addressed informally with our without the help of NCM staff)

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* 13. I have sent the following forms to NCM for this trimester:

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* 15. How would you rate the performance of the supervisor?  If you did not work with a supervisor this trimester, please select N/A

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* 17. How would you rate the performance of the supervisor?  If you did not work with a supervisor this trimester, please select N/A

 
50% of survey complete.

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