Exit Survey
We appreciate your time in filling this out. Please answer the below questions based on the recent rural rotation you completed through Southern Utah AHEC.
First and last name *
First and last.
Your answer
Who was your Preceptor? *
ex. Jon Doe at Blanding
Your answer
When were you there?
ex. 10/02/2013-10/29/2013
Your answer
What is the town where you graduated from high school? *
ex. Monte Vista
Your answer
What is the state where you graduated from high school? *
ex. Colorado
Your answer
What was the most memorable experience during your rotation?
Your answer
Why did you choose Southern Utah as the site for your rotation?
Your answer
What do you see as some of the greatest health care needs in this area?
Your answer
What do you see as the largest difficulty or challenge in practicing rural health care?
Your answer
What are your long term career plans? Specialty? Do you plan to practice in a rural area?
Your answer
Please respond to the following statements.
1 = Does not meet minimum requirements. Not acceptable.
2 = Improvement necessary. Below average. Below expectations.
3 = Meets placement requirements. Meets expectations. Average.
4 = Exceeds placement requirements. Above expectations. Above average.
5 = Far exceeds placement requirements. Exceeds expectations. Excellent performance.
I was given sufficient opportunity to practice clinical skills.
3
Not Acceptable
Exceeds Expectations
I received an orientation for this placement that provided me with sufficient information to function effectively in this setting.
Not Acceptable
Exceeds Expectations
I have increased my knowledge of access barriers to health care.
Not Acceptable
Exceeds Expectations
I have increased my knowledge and sensitivity to patients’ cultural backgrounds.
Not Acceptable
Exceeds Expectations
I have increased my understanding of effective interdisciplinary patient care.
Not Acceptable
Exceeds Expectations
My Knowledge of access challenges and other barriers to health care PRIOR to completing this training.
Poor
Excellent
My knowledge of access challenges and other barriers to health care AFTER completing this training experience.
Poor
Excellent
My knowledge and sensitivity of cultural issues in health care PRIOR to completing this training experience.
Poor
Excellent
My knowledge and sensitivity of cultural issues in health care AFTER completing this training experience.
Poor
Excellent
My understanding of effective inter-professional health care teams PRIOR to completing this training experience.
Poor
Excellent
My understanding of effective inter-professional health care teams AFTER completing this training experience.
Poor
Excellent
My intent to provide primary care PRIOR to completing this training experience.
Poor
Excellent
My intent to provide primary care AFTER completing this training experience.
Poor
Excellent
My intent to practice in a medically underserved site PRIOR to completing this training:
Poor
Excellent
My intent to practice in a medically underserved site AFTER to completing this training:
Poor
Excellent
My preceptor provided me with appropriate supervision.
Not Acceptable
Exceeds Expectations
I am aware of options to continue a mentoring relationship with my preceptor.
Not Acceptable
Exceeds Expectations
My intent to practice in a rural area PRIOR to completing this training experience.
Poor
Excellent
My intent to practice in a rural area AFTER to completing this training experience.
Poor
Excellent
Any additional comments or concerns:
Optional
Your answer
Thank You and Good Luck With Your Future Endeavors!
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