subject_line
PRECEPTOR EVALUATION
Preceptor:
Last Name
*
Date:
*
+
Domain:
Learning Climate
Learning Climate Level:
Level 1
Level 2
Level 3
Level 4
Level 5
Learning Climate
*
Level 1
Does not discuss my goals
and objectives
Does not set expectations
for the shift
Supervisor's behavior is
unprofessional
Does not use my name in
interactions
Level 2
Exclusively waits for me to
find learning opportunities
(patients, procedures,
interesting exam findings)
I was treated as an observer
or shadow
Level 3
Teacher discusses own
goals and expectations for
me near start of shift
Sets general, nonspecific
learning goals
Teacher seeks out learning
opportunities with me
Supervisor was professional
in interactions with me
Level 4
Goals are learner-centered
Sets own expectations for
shift while also soliciting
my expectations
Seeks out learning
opportunities that match
my goals and objectives
Level 5
Works with me to match my
goals with his/her assessment
of my educational needs
Supervisor is a professional
role model
Transmits enthusiasm for
learning environment
Domain:
Content Teaching
Content Teaching Level:
Level 1
Level 2
Level 3
Level 4
Level 5
Content Teaching
*
Level 1
Repeatedly avoids teaching
opportunities
Does not elucidate my
thought process
Teaches with a didactic
approach
Level 2
Teaching points unrelated to
recent or current patient
encounters
Teacher's style primarily
didactic but incorporates
interactive components
Teaching points do not match
my own perceived ability
Level 3
Chooses topics for mini
lessons based on recent or
current patient encounters
Encourages me to share and
justify my thought process
Uses additional resources
(electronic, text, etc) to
answer clinical questions
Level 4
Topics related to
goals/objectives
Topics are patient-centered
and evidence-based
Guides me in the acquisition
of information to answer
clinical questions
Teaching points target areas
for improvement in my
knowledge base
Level 5
Effectively uses teachable
moments to teach subjects
pertinent to patient
encounters
Uses targeted questions to
guide my clinical reasoning
Teaching points involve
ED-wide and/or system-level
effects on patient care
Teaching points are patient-
centered and evidence-based
Domain:
Supervision
Supervision Level:
Level 1
Level 2
Level 3
Level 4
Level 5
Supervision
*
Level 1
Supervisor present only when
asked
Supervisor institutes care
plan without reverence to
and independent of my input
Level 2
Supervisor sees the majority
of my patients with me (I am
observed or observe my
supervisor)
While care plans are
discussed, orders are entered
for me by my supervisor
Level 3
Supervisor sees the majority
of my patients independently
while I work on other tasks
Heavily guides development
of the patient care plan
Provides guidance when
requested/needed or
during teachable moments
Level 4
Sees patients independently
and in an unobtrusive manner
Recognizes when I need more
guidance, stepping in when
appropriate
Guides me in the acquisition
of information to answer
clinical questions
Teaching points target areas
for improvement in my
knowledge base
Level 5
Provides appropriate balance
of supervision and autonomy
tailored to my level of training
and skill
Allows me to integrate my
supervisor’s experienced
perspectiveinto my own
decision making
Domain:
Feeback and Evaluation
Feedback and Evaluation Level:
Level 1
Level 2
Level 3
Level 4
Level 5
Feedback and Evaluation
*
Level 1
Does not provide feedback
at all
Level 2
Provides excessive, general,
or unhelpful feedback
Provides brief, non-specific
feedback that is primarily
positive in nature (ex: "Great
job”)
Level 3
Provides specific, positive
feedback
Able to provide general or
non-specific constructive /
negative feedback
Feedback is timely in nature
Level 4
Provides a mix of positive
and negative feedback
Readdresses feedback
Feedback given throughout
shift
Level 5
Provides appropriate balance
of supervision and autonomy
tailored to my level of training
and skill
Allows me to integrate my
supervisor’s experienced
perspectiveinto my own
decision making
In this space, please take a moment to provide some specific comments for your preceptor, including positive feedback and opportunities for improvement:
Comments