SIU Department of Family and Community Medicine. PO Box 19671, Springfield, IL 62794-9671, 217-545-0200
link to Family and Community Medicine Home Page
link to Family and Community Medicine Residencies Page
link to Family and Community Medicine Education Page
link to Family and Community Medicine Research Page
link to Family and Community Medicine Clinical Services Page
Preceptors
SITE VISIT CHECKLISTA Department of Family & Community Medicine medical student education faculty member will visit with the student and his/her preceptor, during the second week of the preceptorship, to ensure that the student is exposed to appropriate ambulatory and hospital experience. Below is a list of the areas that are reviewed with the student and preceptor.
 
 
Preceptor: ___________________________________________ Date: ________________

Student: _____________________________________________

INSTRUCTIONS: For each of the items listed below, either place a check mark in the space, if that item is being performed satisfactorily, or a "0" if it not being done. For some items, a number will be appropriate.
 
 
Physician's Teaching Style Comments
___Preceptor allows active student learning/work;  not shadowing: _________________________________________
___Student presents case to preceptor and formulates  management plan (more then H/P info) _________________________________________

___Physician then questions and comments
_________________________________________

___Preceptor observes at least one complete exam and several focused parts
_________________________________________

___Physician and student recheck patient together
_________________________________________

___Student writes or dictates progress note
_________________________________________

___Student writes SOAP notes (should write at least 10 notes for clerkship)
_________________________________________

___Student writes prescriptions
_________________________________________

___Office procedures performed by student
_________________________________________

___Physician allows time for student to read
_________________________________________

 
Physician's Practice Comments
___Night call (number of times per week) _________________________________________

___OB (number of deliveries per week)
_________________________________________

___Gyne (percentage of practice)
_________________________________________

___Peds (percentage of practice)
_________________________________________

___Geriatrics (percentage of practice)
_________________________________________

___Student examines 8-10 patients per day (not too many more)
_________________________________________

___Hours/days in office daily
_________________________________________

___% of time student spends w/ primary preceptor
_________________________________________

___Nursing home visits (number made)
_________________________________________

___Home visits (number made)
_________________________________________

___Attends Family Practice business meetings (hospital, partner meeting, committees, etc.)
_________________________________________

___Student attends a family conference or counseling session (if available)
_________________________________________

 
Hospital Practice Comments
___Student admits at least three (3) patients per week _________________________________________

___Student follows at least three (3) patients per day in hospital
_________________________________________

___Student does initial work-up and progress notes
_________________________________________

___Student assists with procedures
_________________________________________

___Student writes management plan in chart or on order sheet
_________________________________________

___Student writes SOAP notes in chart
_________________________________________

___Student writes/dictates discharge summary on at least one patient
_________________________________________

___Student is allowed to leave clinic some but not too much to admit patients to the hospital
_________________________________________

___Student examines patients in the ER and/or follows FP patient into surgery
_________________________________________

 
Other Comments
___Student observes procedures on FP patients (i.e. x-rays, EMG, echo, etc.) _________________________________________

___Student works with other physicians or health care providers (i.e. PA, NP, etc.)
_________________________________________

 
Student Comments
___Stays in community/commutes from home _________________________________________

___Accommodations are satisfactory
_________________________________________

___Student seems to be happy and doing well
_________________________________________

___Reminded of Health Care in the Community visit, EBM, which common problem, Read Sloane, Extra credit paper and return date, Social Gathering
_________________________________________

___Call Room-Ask student if he/she has secure place to put belongings during the day
_________________________________________

 
Student/Preceptor Comments
___Student/preceptor relationship is satisfactory _________________________________________

___Preceptor is happy with student's performance
_________________________________________

___Preceptor reminded to complete mid-preceptorship evaluation and to give feedback to student
_________________________________________


Family and Community Medicine Home / Residencies / Education / Research / Clinical Services
SIU-SM Home / About SIU-SM / Directories / News/Info / SIU Carbondale / Search / Privacy Policy

©2011 - 2012 Board of Trustees, Southern Illinois University
Contact the webmaster..........Last Updated 00/00/00