CLERKSHIP FINAL 2010

STUDENT'S PERSONAL EVALUATION OF CLERKSHIP PROGRAM

BARRY UNIVERSITY SCHOOL OF PODIATRIC MEDICINE & SURGERY

PLEASE COMPLETE WITHIN TWO WEEKS AFTER ROTATION

STUDENT ID#

ROTATION MONTH:

1. Name of program:

2. City & State of Program

3. Most Time Spent In:

Office

Hospital

Clinic

Surgery Center

4. Percentage of Time Spent With:

% Resident

% Director

% Attending

5. Are Students Allowed To Treat Patients?

Yes

Sometimes

6. Average number of in-patients on list:

7. Do Students Go On Hospital Rounds?

If yes, what time did you arrive at the hospital?

8. Is there a student-run clinic?

If Yes, how many days per week were you there?

9. Were students allowed to write notes?

Yes

10. Do Students Participate In Casting?

Yes

11. Surgery: Do students participate?

Yes

Scrub In:

Yes

Observe:

Yes

Suture:

Yes

12. Do Surgical Procedure Skin to Skin?

Yes

13. Are Lectures, Seminars, or Journal Clubs Held?

Yes

14. Is Housing Provided?

Yes

15. Are Meals Provided?

Yes

16. How many miles were you required to drive to outside offices/surgery centers per week?

None

1-5

6-10

11-15

>15

17. Is a car necessary?

Yes

18. What was your out-of-pocket cost to attend this program?

19. What Special Projects are Required? (Presenting Case Histories, Preparing a Paper, Etc.)

20. Will Having the Clerkship Help You Get the Residency?

If yes, explain:

21. What were your chief responsibilities at this program?

22. What were the most valuable learning experiences of the program?

23. What aspects of the program need most improvement and/or attention? (Make suggestions)

24. Can you suggest ways of improving this evaluation form?

25. Rate your program on a scale of 1-10 with 10 being the best possible response:

26. Additional Comments: