CLINICAL SUPERVISOR EVALUATION TOOL: Please ask your student to complete this form so that it may help to inform your further development as a Clinical Supervisor. Clinical Supervisor Name: Student Name: Date: How much do you agree with the following statements? (Please Circle) Strongly Agree Neutral Disagree Strongly Statement Agree Disagree I felt welcomed and accepted by my clinical 1 2 3 4 5 supervisor (CS) My CS demonstrated enthusiasm in their 1 2 3 4 5 preceptor role My CS communicated in a manner that 1 2 3 4 5 displayed respect for me as a student 1 2 3 4 5 My CS communicated to me in a clear and helpful manner My CS was professional in attitude toward 1 2 3 4 5 patients, relatives and other health professionals My CS functioned as a role model during my 1 2 3 4 5 Professional Experience Placement My CS functioned as a resource person 1 2 3 4 5 during my Professional Experience Placement My CS assisted in providing opportunities to 1 2 3 4 5 optimise my learning I received an appropriate level of support 1 2 3 4 5 and supervision from my CS My CS provided guidance without taking 1 2 3 4 5 over the experience My preceptor provided explanations and 1 2 3 4 5 rationales for procedures My CSencouraged extension of my 1 2 3 4 5 knowledge base and to make links between theory and practice My preceptor encouraged me to use 1 2 3 4 5 problem solving skills independently My CS challenged my knowledge and 1 2 3 4 5 reinforced learnt principles 1 2 3 4 5 My CS encouraged me to ask questions and seek assistance
CLINICAL SUPERVISOR EVALUATION TOOL: Please ask your student to complete this form so that it may help to inform your further development as a Clinical Supervisor. Clinical Supervisor Name: Student Name: Date: How much do you agree with the following statements? (Please Circle) Statement Strongly Agree Agree Neutral Disagree Strongly Disagree I felt welcomed and accepted by my clinical supervisor (CS) 1 2 3 4 5 My CS demonstrated enthusiasm in their preceptor role 1 2 3 4 5 My CS communicated in a manner that displayed respect for me as a student 1 2 3 4 5 My CS communicated to me in a clear and helpful manner 1 2 3 4 5 My CS was professional in attitude toward patients, relatives and other health professionals 1 2 3 4 5 My CS functioned as a role model during my Professional Experience Placement 1 2 3 4 5 My CS functioned as a resource person during my Professional Experience Placement 1 2 3 4 5 My CS assisted in providing opportunities to optimise my learning 1 2 3 4 5 I received an appropriate level of support and supervision from my CS 1 2 3 4 5 My CS provided guidance without taking over the experience 1 2 3 4 5 My preceptor provided explanations and rationales for procedures 1 2 3 4 5 My CSencouraged extension of my knowledge base and to make links between theory and practice 1 2 3 4 5 My preceptor encouraged me to use problem solving skills independently 1 2 3 4 5 My CS challenged my knowledge and reinforced learnt principles 1 2 3 4 5 My CS encouraged me to ask questions and seek assistance 1 2 3 4 5
CSevaluationTool.docx