|
Y1 Mentor Log
| Student Name: |
|
|
Date: (MM/DD/YY) |
|
|
Unit:
|
|
| Name of Physician/Mentor:
|
|
|
Specialty:
|
|
|
Length of Visit (in hours): |
|
| Type of Experience: |
|
| Patient Age: |
|
|
Patient Gender: |
|
| Primary Diagnosis:
|
|
| Procedure: |
|
|
Observed or Participated? |
|
Learning issues generated for
further study:
|
| |
|