• Elective Evaluation

    Student Portion

  • Please make sure you use the PRE-FILLED elective evaluation form link that you received by email. If the form below is not partially filled, please close this form and look for the pre-filled form link in your email. The email was sent by Juliette Wertz on the Monday following the last day of your elective, with the submject "Student Elective Evaluation".

  • Student Information

  • Class*

  • Life numbers must match!

  • ELECTIVE INFORMATION

  • Elective Type*
  • grading criteria
  • Is this Elective Longitudinal*
  • Number of Weeks*
  • The date range above is:*
  • Start Date*
     - -
  • Completion Date*
     - -
  • Research/ Non Clinical Evaluation Criteria 
    PASS FAIL
    UNDERSTANDING
    • Demonstrated understanding of concepts or tasks to be performed
    • Could not provide basic understanding of concepts or tasks to be performed
    • Student demonstrates understanding of advanced concepts
    • Student demonstrates basic understanding of concepts
    PROFESSIONALISM
    • Arrived on time and prepared
    • Ready to receive feedback and suggestions 
    • Integrated feedback
    • Considerate of others' time and value to the team
    • Arrived late regularly; unscheduled absences
    • Inappropriate conduct
    ABILITY
    • Able to perform task/work outlined with minimal supervision
    • Demonstrated knowledge or interpretation of tasks
    • Unable to perform tasks/work outlined for the elective
    INITIATIVE & RESPONSIBILITY
    • Appropriate with some supervision to move forward
    • Completed tasks when assigned by team 
    • Took ownership and direction of the work required
    • Low level and unable to move forward
    TEAMWORK & COMMUNICATION
    • Worked well with others
    • Effective member of the team
    • Kept team informed on progress or any questions or challenges
    • Poor teamwork, poor collaboration
    • Poor communication (oral or written)

  • Clinical Elective & Clinical Tailor Made 

    Evaluation Criteria 
    Preparation and Participation
    Student consistently arrives exceptionally well prepared and actively contributes to the learning environment. Student arrives prepared to participate. Student generally arrives unprepared to participate.
    Knowledge of Medical Concepts
    Student demonstrates understanding of advanced concepts. Student demonstrates basic understanding of concepts. Student cannot provide basic understanding of concepts.
    Application and Communication of Medical Knowledge to Clinical Care
    Shares knowledge with others in the clinical setting. Demonstrates knowledge gained without prompting. Unable to demonstrate knowledge gained, even with prompting.
    Psychomotor Skills
    Can perform psychomotor skills relevant to the elective with supervisor available. Can perform psychomotor skills relevant to the elective with supervisor assisting. Unable to perform psychomotor skills relevant to the elective even after supervisor coaching.
    Professionalism
    Is proactive and actively engages with the team bi-directionally. Completes tasks when assigned by the team. Inappropriate conduct, including arriving late regularly or having unscheduled absences.

  • Evaluator/ Faculty Information

  • This is the faculty member who you have worked with during your elective who will be evaluating you. You may only select ONE EVALUATOR PER COURSE. This cannot be a fellow or resident.

  • By submiting this form, you acknowledge that the information provided will be sent to the Evaluator/ Faculty Email for evaluation. 

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