Midpoint Preceptor Evaluation of Clinical Student

Preceptor:

Student: Date:

Respond to the following questions by selecting the most appropriate response regarding
the students' clinical knowledge and professionalism.

Basic Medical Knowledge

1. History taking is accurate and complete.

Unacceptable Needs
Performance Improvement Acceptable Strong Outstanding N/A
O O O O O O
Additional Comment:

2. Pertinent physical exam components are present.

Unacceptable Needs
Performance Improvement Acceptable Strong Outstanding N/A
O O O O O O
Additional Comment:

Professionalism

3. Communicates well with the patient and the medical team.

Unacceptable Needs
Performance Improvement Acceptable Strong Outstanding N/A
O O O O O O
Additional Comment:

4. Exhibits appropriate work ethic.

Unacceptable Needs
Performance Improvement Acceptable Strong Outstanding N/A
O O O O O O
Additional Comment:

5. Demonstrates caring and respectful behaviors.

Unacceptable Needs
Performance Improvement Acceptable Strong Outstanding N/A
O O O O O O
Additional Comment:
 Midpoint Preceptor Evaluation of Clinical Student

Student and Preceptor Reflection on Performance

Comments on specific strengths:

Areas needing improvement:

Plans to address these areas:

Preceptor: I would like the Director of Clinical Education to contact me for discussion.
Yes □ No □

Preceptor Signature Student Signature

Division of Physician Assistant Studies

Clinical Team
1775 North Sector Court, Suite 200
Winchester, VA 22601
Office: 540-542-6208
Email: paclinicalteam@su.edu
Fax: 540-542-6210