FELLOW EVALUATION OF A SUPERVISOR
Fellows should meet weekly for one-to-one supervision with their assigned supervisors, as well as on-demand as required by clinical complexity or workload. Please be candid. This is an anonymous survey. If your anonymity cannot be assured, surveys will be aggregated so you cannot be identified.
Today's Date
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Month
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Day
Year
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Academic Year
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2013-2014
2012-2013
2011-2012
2010-2011
2009-2010
Name of Supervisor
Rotation Site
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Autism Center
C/L @ University Hospital
Challenge Program (PHP) @ UBHC
FXB-Pediatric HIV Clinic
Outpatient @ UBHC
Pediatric Neurology
School Rotation
Specialty Clinics
Supervisor Rating
Rows
Excellent
Very good
Good
Fair
Poor
Supervisor adheres to scheduled meetings
Supervisor creates a collegial atmosphere
Our discussions are relevant and of utility
(S)he encourages and promotes my professional development
My overall learning experience is...
Additional constructive comments
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I attest that I am currently enrolled as a fellow in Child and Adolescent Psychiatry at NJMS and that this is a candid evaluation of a supervisor assigned to me.
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