Clerkship Rotation Evaluation Generic (student)Department : Date: 1. Are the activities meet the minimum activities required in prototypical weeks?

BST Case report

Case presentation

Referat

Medical record 2. Please tell us as detail as possible what are your activities in rotation?

(detail per jam ngapain)3. Do you have access to the patient

a. in RSUS?

1. Ward?2. OT ? b. in SHLV ?

1. Ward? 2. OT ? c. How far you can access the patients? History taking/ physical examination/Communication (Informed consent, health promotion, explanation) 4. Please Describe your responsibilities a. Responsibility for Patient Care under Supervisionb. Medical Records

c. Procedures

5. Have you been provided a SAFE learning environment ?

Where students feel safe to state their opinions,

Where they can admit lack of knowledge or skill without criticism Where mistakes are seen as learning opportunities Where students are encouraged to ask questions. Where there are no stupid questions and there are no dumb answers Where feedback is given in a safe and constructive mannera. Is it safe and friendly ?

b. Is it unfriendly? Please describe why?

6. Preceptors

a. How does Your preceptors function ? b. Includes students as team member? c. How much time with preceptor every day? i. In SHLV : .. hours everydayii. In RSUS : .. hours everyday7. Are your teachers teaching?

a. Informal b. Formal c. Are there any Teaching /Learning Problems? d. Please identify your top 2 or 3 Outstanding Teachers : 8. Assessments

a. How did your Preceptor assess your knowledge?

i. Work-based assessment ii. Case discussions

iii. MiniCEX

b. Do you receive the Global Assessment i. In mid rotation? ii. In end rotation ?

c. Which assessment of Performance do you do?

i. MiniCEX( ii. OSCE ( iii. Other :iv. Workbased ( d. Were your reports scored ?

i. Case reports scoring? ii. Case presentations scoring ?

iii. Referat scoring?iv. Records ? 9. Did you receive your scores in less than 1 month after the rotation

10. How were you provided Feedback

a. Work based ( b. Global Assessment of performance? i. During rotation ?

ii. Did you have and End of rotation close out discussion ? 11. Please provide your Suggestions to Improve the rotation: