Y2 Mentor Evaluation

Student Name: 


Name of Mentor: 

Note to student:  Please help us evaluate the mentor portion of the clinical mentor program.  Be specific about strengths and weaknesses in your comments.  Feel free to discuss any comments that you do not wish to put in writing with a member of the Doctoring Staff.  THANK YOU! 
Evaluation data is not sent to the mentor on a yearly basis so that comments are less likely to be attributed to an individual student.  Instead, feedback may be given to the mentor in aggregate form every few years.

How do you feel about the following statements? Strongly Disagree Disagree Undecided Agree Strongly Agree
My physician mentor was flexible in setting up clinic times
My physician mentor was helpful in finding me other clinics when a make-up clinic was needed.
My physician mentor let me see patients on my own.
My physician mentor watch me take a history.
My physician mentor let me present the patientís findings (even if in 90 seconds).
My physician mentor asked me to develop/present my management plans for the patients I saw.
My physician mentor watched me perform the physical examination (beyond what was required for the exam cards).
My physician mentor provided helpful feedback on write-ups.
My physician mentor provided feedback on oral case presentations.

The following questions are open ended -- answer appropriately.

How many of the following did you perform in your physician mentor clinic?

Pap or Pelvic




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, labor & delivery, nursing home visits, ED visit, Home Visits, etc)

3.  If your mentor used an EHR, did your mentor allow you to access the EHR in the course of patient care?

Yes      No

4.  Please list any problems you had with your physician mentor:

5.  Would you recommend this physician mentor for other second year students? 

Yes      No

Please comment.


Contact us: Leslie Montgomery (Curriculum Information)
Jean Afflerbach (Web Master)

Page last updated Tuesday April 24, 2018

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