Appendix H: Chair's Site Visit Form

STUDENT PERSPECTIVESRATINGS
Instructions: Question details: Please rate the following areas from the students’ point of view, on a scale of 0-5 as defined below.5 = Highly Effective; 4 = Very Effective; 3 = Fairly Effective; 2 = Minimally Effective; 1 = Not Effective; 0 = Not Done;  Y= Yes; N= No
Please provide ratings only for global questions (the first question that is bolded in darker highlighted color). If the global question rating is a 3 or below then please enter all sub component fields below.
How effective was the clinical site orientation?                                                                                                      
Did it include the following: 
Review of relevant sections of the Clinical Training Manual, including educational objectives, assessments and required activities (e.g., web-based learning, written and oral assignments)? 
Opportunities to develop communication skills? 
An introduction to the key faculty and coordinators? 
A tour of the department’s service areas and facilities? 
An explanation of schedules? 
The orientation made the students clear about what they are supposed to learn during the clerkship, the required clinical experiences and how they will be assessed? 
Comments: 
Was there an appropriate amount of time allotted to a variety of clinical experiences, including inpatient, outpatient/ambulatory and on-call experiences? 
Do the clinical experiences match the requirements outlined in the CTM? 
What are the on-call experiences, if any are they valuable? 
Are the students exposed to sufficient volumes and varieties of patients to complete their required clinical experiences? 
Does the presence of other students interfere with SGU students’ educational experience? 
Comments: 
Students receive appropriate supervision in all aspects of this rotation? 
Does supervision focus on the foundations of patient care, clinical skills, chart documentation (either in the patient record or with alternate methods)? 
Are all students directly observed performing (targeted) histories and physicals? 
Comments: 
Clinical rounds occur daily and are an effective part of the educational experience? 
Are they led by a faculty member? 
Is there student participation? 
Do they include student presentations? 
Is there input from residents? 
Are students assigned to a team? 
Comments: 
Lectures, clinical discussions and preceptor sessions are adequate in number, interactive, relevant to the curriculum? 
Do they include students as presenters and discussion leaders? 
Is there feedback to students when they are presenters or discussion leaders? 
Is the web-based department curriculum being completed? 
Are the required Communication (Drexel) & Ethics modules being completed? 
Is UWorld being utilized? 
Comments: 
The required number of write-ups is an effective way for faculty to give formative feedback on clinical skills and student documentation skills? 
Are the write-ups being critiqued and returned in a timely manner so that students can achieve ongoing improvement in their written work? 
Comments: 
Are the students given access to electronic medical records and laboratory data utilizing personal identification numbers? 
Do they have access to a library with appropriate reference material and internet access? 
Do they have lockers or a safe place to leave their belongings? 
If students take call, do they have on-call rooms? 
Comments: 
The mid-core assessment provides useful formative feedback midway through the clerkship or earlier to improve student deficiencies?          
How are the faculty tracking theses assessments? 
Are more frequent evaluations done when problems are encountered? 
Are the evaluations formative? 
Do they include review of the electronic Patient Encounter Logs and inquiry into manual skills experience? (Manual skills training and assessment is only required in the surgical clerkship). 
Is there an inquiry into progress on web-based requirements (Communication, Ethics, etc.)? 
Are the students’ clinical skill and professional behavior being assessed? 
Are students made aware of their positive/negative behaviors as perceived by the faculty? 
Are the midcore evaluations being documented and submitted? 
If not done yet, do students understand the goals of the mid-core assessment? 
Do students receive narrative (written, long-form) feedback? 
If students from previous rotations are available, were grades returned in a timely fashion? 
Comments: 
There is adequate time available for required course activities (required readings and modules, UWorld, etc.). 
Students work less then 50 hours per week? 
Students have adequate non-clinical independent study time? 
The preceptors provide high quality teaching? 
The preceptors provide high quality mentoring? 
The teaching and assessments of clinical skills and professional behavior were effective during this clerkship? 
Does the faculty review the student portfolio, consisting of the Patient Encounter Log and proof of completion of the required web-based courses? 
The faculty utilize questions to assess communication skills, empathy and critical thinking? 
Is professional behavior emphasized and discussed with students? 
Comments: 
The residents (if applicable) are knowledgeable and eager preceptors? 
They integrate the students into the clinical activities effectively? 
They are role models for professional behavior or otherwise exceptional teachers that should be noted? 
Comments: 
The attendings are available, experts in their field and eager to teach? 
They motivate and inspire the students? 
They are role models for professional behavior or otherwise exceptional teachers that should be noted? 
Comments: 
Students are treated with respect and the atmosphere/learning environment was conducive for an effective educational experience?    
 
All healthcare workers, patients and visitors are treated with respect? 
The rotation provides a professional, respectful, and intellectually stimulating academic and clinical environment? 
The rotation recognizes the benefits of diversity, and promote students’ attainment of competencies required of future physicians? 
Do students experience mistreatment? 
Do they know how to report mistreatment if they did experience it? 
Are students’ duty hour requirements respected? 
Have students developed interactive relationships with the nursing staff, physician assistants, nurse   practitioners, technicians and social workers? 
Is the staff welcoming to the students, and have the students learned to seek out these relationships? 
Comments: 
Students have access to healthcare?  
Do they have access to mental healthcare? 
Do students know what to do if they are exposed to an environmental hazard? 
Comments: 
  
Faculty Perspective 
Overall, how well does the clerkship meet the objectives and assessments and follow the guidelines as published in the Clinical Training Manual? 
Comments: 
Do the faculty know the MD program objectives, learning objectives, required clinical experiences, and assessment system?    
Do faculty receive communications from SGU and departmental leadership? 
Are faculty invited to/aware of meetings? 
Do faculty know how they can participate on committees? 
Do faculty know how to access data on student performance and satisfaction at their site (using the Clinical Evaluation program or requests from Office of Dean)? 
Comments: 
What is the atmosphere like for students and are students treated with respect?    
Are all healthcare workers, patients and visitors treated with respect? 
Does the rotation provide a professional, respectful, and intellectually stimulating academic and clinical environment? 
Does the rotation recognize the benefits of diversity, and promote students’ attainment of competencies required of future physicians? 
Do faculty know how to report mistreatment? 
Comments: 
The preceptors and residents understand that the average workday or week should not exceed 50 hours; 30% of this time must be protected academic time consisting of conferences and independent study?Yes/ No
  
Do residents participate in teaching? 
How are the residents trained to be teachers? 
How do they know the SGU MD program objectives, learning objectives, required clinical experiences, and assessment system? 
Comments: 
The mid-core assessment provides useful formative feedback midway through the clerkship or earlier to improve students' deficiencies?    
How are the faculty tracking these assessments? 
Are more frequent evaluations done when problems are  encountered? 
Are the evaluations formative? 
Do they include review of the electronic Patient Encounter Logs and inquiry into manual skills experience? (Manual skills training and assessment is only required in the surgery clerkship). 
Is there an inquiry into progress on web-based requirements? 
Are the students’ clinical skills and professional behavior being assessed? 
Are the evaluations being documented and submitted? 
Do students receive narrative (written, long-form) feedback? 
Are grades returned in a timely fashion after the completion of a clerkship? 
Comments: 
Are faculty aware of the faculty policies/handbook, e.g., how to obtain appointments or get promoted? 
Do faculty have access to faculty development? 
Do faculty know how to access SGUSOM’s faculty development resources? 
Have they watched the faculty development videos? 
Do faculty receive any formative feedback from SGUSOM, including annual performance evaluations? 
Comments: 
Do the faculty have any suggestions to improve the clerkship? 
Comments: 
Site Visitor’s Evaluation and SummaryComment box will expand for text
This section is for the discussion of the site strengths in the given discipline, typically things that the students like and/or that the faculty are doing well. 
This section is for the discussion of the site weaknesses in the given discipline, typically things that the students do not like and/or that the faculty are not doing well, especially if they are out of compliance with the school’s requirements 
This section is for the discussion of site opportunities in the given discipline, typically things that are external to the site itself. 
This section is for the discussion of threats to the site in the given discipline, typically things that are external to the site itself. 
This section is for detailing the initial plan to address weaknesses and/or threats. It may be subject to approval by administration and/or the Curriculum Committee, depending on the nature of the plans 
Other comments: This section is for any additional comments that the site visitor wishes to include about   the site/visit.