Family & Community Medicine Clerkship - FCMED 771
Mid Clerkship Formative Evaluation
Academic Year 2009/2010
Date:
Student Name:
Patient encounter log reviewed
Clerkship procedure/observed examination log reviewed
Opportunities to complete choice procedures during clerkship discussed
Feedback from faculty/residents shared
Student concerns discussed
Recommendations made to enhance student performance
Modifications made to ensure completion of required encounters/procedures
Other comments:
I have received and read a copy of my Family & Community Medicine Clerkship - FCMED 771 Mid Clerkship Formative Evaluation.
Student Signature: Date:
Preceptor Signature: Date:
