clerkship handbook - University of Hawaii – Department of Medicine

U.H. John A. Burns School of Medicine
Third-Year Clerkship in Internal Medicine
SMALL GROUP LEARNING EXPERIENCE
Evaluation Form
Student: ____________________ Date: _________ Activity: ____ PBL Tutorial
____ Bedside Clinical Skills
____ Chief Rounds
____ Other: ___________
Check appropriate box on this Rating Scale:
Activity
Participates actively
Shares knowledge
Respects opinions and learning
needs of others
Asks thoughtful questions
Facilitates group process
Demonstrates appropriate fund
of knowledge for MS3
Demonstrates appropriate
clinical skills for MS 3
Is properly prepared for this
activity
Evaluator Comments:
Exceptional
Very
Competent
Competent Marginal Unsatisfactory
Evaluator’s name: ___________________ Evaluator’s signature: _____________________
Student’s signature _________________
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