Student Evaluation

Please enter the name of the student you worked with and are evaluating here:

Reviewer name:

Please mark how often you worked with this student:
Every day
A few times a week
A few times over the month
Not often

Please mark the answer that best desribes this student with regard to professionalism and work ethic:
Excellent
Very good
Neutral
Not great
Poor

Please mark the answer that best desribes this student with regard to patient care and clinical skills:
Excellent
Very good
Neutral
Not great
Poor

Please mark the answer that best desribes this student with regard to communication/interpersonal skills with patients:
Excellent
Very good
Neutral
Not great
Poor

Please mark the answer that best desribes this student with regard to communications/interpersonal skills with colleagues and staff:
Excellent
Very good
Neutral
Not great
Poor

Please mark the answer that best desribes this student with regard to initiative and motivation for learning, response to feedback:
Excellent
Very good
Neutral
Not great
Poor

Please mark the answer that best desribes this student with regard to medical records and compliance with institutional regulations:
Excellent
Very good
Neutral
Not great
Poor

I would want to work with this student in the future
Agree
Somewhat agree
Neutral
Somewhat disagree
Disagree

I would recommend this student to the residency director for acceptance:
Agree
Somewhat agree
Neutral
Somewhat disagree
Disagree

Please make any comments below as to this student’s performance: