Externship Site Evaluation
Surry Community College
Medical Assisting Program
Name:
Instructions: Consider each item separately and rate each item independently of all others. Darken the circle that indicates the extent to which you agree with each statement. Please do not skip any rating.
Strongly Agree-5 Generally Agree-4 Neutral (acceptable)-3 Generally Disagree-2 Strongly Disagree-1 N/A - This activity is not available at this time.
At this internship site, I was:
Strongly Agree-5
Generally Agree-4
Neutral (acceptable)-3
Generally Disagree-2
Strongly Disagree-1
N/A
1. Provided orientation to the office/facility
2. Assigned to a supervisor/preceptor who actively participated in my learning experience
3. Allowed to perform the entry-level skills I had learned in school
4. Given the opportunity to perform administrative skills
5. Given the opportunity to perform clinical skills
6. Adequately supervised and knew who to ask for help if I needed it
7. Treated respectfully by healthcare providers and other staff
8. Provided with adequate personal protective equipment (e.g. gloves) to protect my health and safety
9. Able to communicate effectively with:
Strongly Agree-5
Generally Agree-4
Neutral (acceptable)-3
Generally Disagree-2
Strongly Disagree-1
N/A
a. Supervisory Personnel
b. Staff and co-workers
c. Physicians/health-care professionals
d. Patients/health-care workers