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Health Sciences

College of Education and Professional Studies

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Department of Health Sciences
(509) 963-1912
jan.clark@cwu.edu

Preceptor Evaluation Form

Paramedicine Program

All information collected is strictly confidential. Your primary preceptor for each shift should be evaluated fully with honest, constructive information. A preceptor evaluation form must be completed for each 48 hour shift. Even if you have previously rated the preceptor, you must complete one evaluation for each shift.

Introduced self & applicable personnel; checked out the vehicle with student at the beginning of the shift; reviewed equipment operations (including radio operations).
Introduced self and clearly explained his/her expectations of the student.
The preceptor provided opportunities to review information or skills; assisted student with performance weaknesses; supported EMS Education Faculty’s educational process.
Demonstrated a professional attitude towards the student’s learning experience.
Including, but not limited to: consistently honest; demonstrated ability to be trusted with the property of others or confidential information; completely and accurately documented patient care and learning activities.
Including, but not limited to: showed compassion for others; responded appropriately to the emotional response of patients, family members, and students; demonstrated respect for others; demonstrated a calm, compassionate, and helpful demeanor toward those in need; was supportive and reassuring to others.
Clothing and uniform was appropriate, neat, clean, & well maintained; exhibited good personal hygiene and grooming.
Demonstrated the ability to trust personal judgment; displayed an awareness of strengths and limitations; exercised good personal judgment.
Examples included, but were not limited to: listened actively; provided constructive criticism & discussion with student regarding expectations, performance, remediation, & positive reinforcement; adjusted communication strategies to various situations.
Consistently punctual; rapid response times.
Placed patient care above all else; helped and supported students; showed respect for all team members; remained flexible and open to change; communicated with students/fire department personnel to resolve problems.
Was polite to others; did not use derogatory or demeaning terms; behaved in a manner that brought credit to the profession.
Did not allow personal bias or feelings interfere with patient care or the student’s educational process; provided accurate evaluation of student performance in order to provide a highly effective learning environment; protected and respected patient/student confidentiality and dignity.
Demonstrated mastery of skills/knowledge; exhibited ability to use resources to find information; displayed a thorough knowledge of local protocols and ambulance operations; followed policies, procedures and physician/medical command orders.

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