Name of Mentor:
Using the scale below, select the appropriate
number for each statement:
1 = Strongly Disagree
2 = Disagree
3 = Undecided
4 = Agree
5 = Strongly Agree
My physician mentor was helpful in finding me other clinics when a make-up clinic was needed.
The following questions are
open ended -- answer appropriately.
1. What other
procedures did you observe/perform with your physician mentor?
(for example, skin cryo, skin incisions/drainage, skin biopsy, injections, blood draws,
urine testing, etc.)
2. What other
activities did you do with your mentor? (for example, hospital
rounds, delivery, nursing home visits, ED, etc)
your mentor used an EHR, did your mentor allow you to access
the EHR in the course of patient care?
your mentor used an EHR, did your mentor have you complete an
office visit note in the EHR for the patients you saw?
any problems you had with your physician mentor:
6. Would you
recommend this physician mentor for other second year students?
Jean Afflerbach (Web Master)
Page last updated
Monday February 23, 2015
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