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Appendix E

University of Colorado Hospital


Evaluation of the Preceptor Form
Complete this form for each preceptor who participates in your orientation.
Return completed forms to your Manager/Educator/Designee. Thank you.

Name of Preceptor: __Pam einke_____________ Date:__!/"!/#$_____________
Name of Preceptee: __%ayla Monto&er____________'nit:__(nc/ )MT_______
Strongly
Agree
Agree Disagree Strongly
Disagree
Prolem Solving!Critical "hin#ing
*elected assignments +ased upon my learning needs ,
*et realistic e-pectations for my performance ,
elped me prioriti.e/ organi.e/ and pro+lem sol&e ,
$esource Utili%ation!Clinical S#ills
Pro&ided me 0ith a kno0ledge of ser&ice1 directed me
to resources including '2 policy and procedures and
the '2 3e+ Page
,
Re&ie0ed the standards for the department/ser&ice
including documentation
,
*upported my research/understanding of diagnoses/
procedures/ and tasks to +e completed and asked key
4uestions to promote my critical thinking skills
,
*uper&ised my performance throughout the shift1 0as
a&aila+le to ans0er my 4uestions
,
Feedac#!Communication
2olla+orati&ely de&eloped my goals/o+5ecti&es for the
ne-t shift
,
Pro&ided daily constructi&e feed+ack1 a&aila+le to
ans0er 4uestions1 used &arious teaching strategies
,
elped me to feel confident and competent1 con&eyed
a positi&e attitude and acted as a supporti&e role model
,
3as easily approacha+le/ patient and encouraging1
respected me as a person and learner
,
Respected co60orkers and patients ,
*upported sociali.ation into the unit/team +y
introducing me to other care team mem+ers
,
Strengths!Areas for &mprovement
3hat did your preceptor do that 0as most helpful7
The most helpful thing Pam did 0as if 8 didn9t feel comforta+le doing something that she
0ould do it first so 8 could o+ser&e and then she 0ould 0atch me do it the ne-t time around. *he
al0ays ga&e feed+ack if it 0as positi&e or gi&ing ad&ice for something that 8 could 0ork on for the
ne-t time. 8 0as ne&er ner&ous asking for help and she 0as great at gi&ing me practice for
delegation and lending a helping hand 0hen she sa0 8 0as o&er0helmed. 3hen 8 0as o&er0helmed
she 0ould gi&e me ad&ice on things to do differently so 8 0ouldn9t +ecome so o&er0helmed.
E&erything Pam taught me 0as ama.ing and got me to 0here 8 am today in my ne0 grad residence:
(ne of the +est preceptors 8 ha&e had::
3hat could your preceptor do differently7
Truthfully 8 can9t think of anything. 8t 0as an all around ama.ing and &ery helpful
e-perience:
;ny other suggestions for impro&ement of your orientation process7
3hite 2opy to Preceptor Personnel <ile1 =ello0 2opy to Preceptor