Department of Family & Community Medicine
Evaluation of Clerkship Activities
Please evaluate your experiences here at the Family & Community Medicine
Clerkship. Be specific about strengths and weaknesses in
your comments. Your honest and constructive criticism will be used
to improve the clerkship for students in the future.
*Select Student Name
useful; 2=Below Average, barely useful; 3=Average; 4=Above Average,
quite useful; 5=Excellent, very useful
Poor ... Excellent
readings complemented similar cases seen and broadened my knowledge base.
group process helped my understanding of the readings.
The process of
connecting and meeting was…
group process provided a useful education tool to facilitate my learning in the FCM clerkship.
information was evidence-based.
The information gained will
be useful in the future.
Patient-Centered Medical Home Reflective Writing
How useful was this assignment?
Appropriate content for your level of training
How useful were the presentations of others?
Quality Improvement Sheet/PDSA
Evidence Plus Worksheet
Health Literacy Assignment
Critical Appraisal/ Pub Med
This helped my understanding of basic &
Encounters/Clinical Competency Exam (CCX)
How would you rate the quality of the cases
(challenging, realistic, etc.)?
How useful was faculty feedback?
Comments/Suggestions: (Please feel free to comment on the SP also)
OSCE Stations: Rate each station on content and how well you think they
assessed your skills.
Chronic Care Model
This was useful for evaluating my knowledge in the
Overall Clerkship Evaluation:
The design and organization of the clerkship
promoted student learning.
Overall rating of the FCM Clerkship
The overall teaching I received was
The overall feedback I received was
The clerkship directly increased my knowledge and
How did the clerkship give you a
better understanding of the discipline of Family Medicine?
List the beneficial/positive
experiences or aspects of this clerkship.
List the negative/weak experiences
or aspects of this clerkship.
What recommendations can you make
for improvement of the clerkship?
Have you personally experienced or
witnessed student abuse during this clerkship? If yes, briefly describe.
this clerkship was an appropriate amount of time devoted to basic science
Other comments or suggestions:
you for taking time to complete this information.
Harald Lausen, DO
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