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We strive to provide students with opportunities & experiences that will allow them to improve their skills in the six core competencies. Your feedback to us regarding what works and is helpful is most useful. Please assist us by completing this survey before you complete your rotations. Thank you very much!
1.
Name of my medical school............
2.
Current year (e.g., 2006)............
3.
Current month (e.g., March)..........
4.
My last name.........................
5.
My first name........................
6.
Number of months I spent at SBH?........
7.
Names of services I served on? .........
8.
I was observed performing Hx and PE?....
a. yes     b. no
9.
I was videotaped with standard. pat?....
a. yes     b. no
10.
Names of faculty who supervised me?.....
11.
Quality of teaching by specific faculty:
12.
Names of PGY-1 who worked with me?......
13.
Quality of teaching by specific PGY-1:..
14.
Names of PGY-2/3 who worked with me?....
15.
Quality of teaching by specific PGY-2/3:
16.
On line references for students helpful?
a. yes     b. no
17.
Please rate usefulness from 1 (worst) to 5 (best) of the following on line references in the six general (core) competencies (MK, ICS, PC, Prof, PBLI, SBP)
  1-poor--2-fair---3-expected4-above avg5-superior
a. Medical Knowledge
b. Communication
c. Patient Care
d. Professionalism
e. PBLI
f. SBP
18.
Was anything particularly useful?.......
19.
Was anything particularly bad?..........
20.
What needs improving?...................