NEPA-AHEC - Student Experiences

Enhancing access to health care through education

Clinical Experience Reporting Form (Exit) CR - 2
for NEPA-AHEC

The Pennsylvania AHEC, in partnership with your school, is seeking to help meet the primary care needs of our communities and to make health careers training a more valuable experience. Results from this survey will be used to support these goals. All survey responses are confidential. Data will only be used within the AHEC program and never for commercial purposes.

Please answer each item as completely as possible.

Today's date? (Month/Day/Year)

Your name? (Last, First, Middle)

What is your current address? (street address, city, state, zip, country)

What is your preferred email address? (Required for online submission)

What is the name(s) of your preceptor(s) responsible for this rotation? (first last)

What is the name of the facility where your rotation took place?

Rotation start date (Month/Day/Year): End date (Month/Day/Year):

How much clinical time did you spend in this training/clinical experience? (If less than 1 day enter “1”.)

Please rate the clinical experience (rotation) you just completed with respect to the following:

Achievement of the learning objectives intended or stated for this experience
Achievement of my personal learning objectives
Accessibility of on-site learning resources (Internet, tutorials, etc.)
Accessibility of preceptor
Opportunity to deliver hands-on patient care

Please rate the following non-clinical aspects of the clinical experience (rotation) you just completed:
If housing was not provided for you through AHEC, Please mark “Does Not Apply

Accessibility of internet and other learning resources from my housing
Quality/Condition of housing
Safety of housing/community

Was the clinical experience (rotation) you just completed labeled as (or could best be considered) which of the following?
Other

What was your status during this rotation?
If undergraduate studies exceed four years, please select ‘Other’ and provide an explanation. Undergraduate refers to medical school as well as a college or university program. Other