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.

Using the scale below, select the appropriate number for each statement:

How do you feel about the following statements?

1 = Strongly Disagree
2 = Disagree
3 = Undecided
4 = Agree
5 = 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 let me present the patient’s findings (even if in 90 seconds).

My physician mentor asked me to develop/present my management plan for the patients I saw.

My physician mentor had me write prescriptions for the patients I saw.

My physician mentor had me write progress notes for the patients I saw.

My physician mentor watched me perform the office examination.

My physician mentor was helpful in finding me patient’s for my H&Ps.

My physician mentor watched me perform my H&Ps.

Comments:

The following questions are open ended -- answer appropriately.
How many H&Ps were in the or on	Office	Hospital	Pediatric Patients	Geriatric Patients

Comments:
How many of the following did you perform in your physician mentor clinic?		Pap or Pelvic Exams	Rectal Exams	Breast Exams

Comments:
1. What other procedures did you observe/perform with your physician mentor? (for example, skin cryo, skin excision, flexible sigmoidoscopy, treadmills, etc.)
2. What other activities did you do with your mentor? (for example, hospital rounds, delivery, ER, etc)
3. Were there any problems with your physician mentor?
4. Would you recommend this physician mentor for other second year students?	Yes		No
Please comment.

Page last updated Monday June 02, 2008