1. On a scale of 1-4; 4 indicating most positive experience, please rate your satisfaction in the following areas:

Please mark the appropriate grid for each question

Very
Satisfied
(4)

Somewhat
Satisfied
(3)

Somewhat
Dissatisfied
(2)

Very
Dissatisfied
(1)

N/A

A. The quality of instruction provided by your preceptor

B. The amount of time your preceptor spent with you

C. The quality of feedback provided by your preceptor

D. The amount of structure the rotation provided

E. The degree to which your clinical skills improved

F. The friendliness of the health center staff

G. The adequacy of your housing & travel arrangements (if provided)

H. The overall rotation experience

2. Please rate the extent to which you agree with the following statements:

Because of this rotation:

Strongly
Agree

Agree

No
Opinion

Disagree

Strongly
Disagree

A. I am more comfortable counseling patients with different cultural and economic backgrounds

B. I can better identify the health status of the community

C. I can better identify those groups in the community that are “at risk” or that have special needs

D. I can better identify those public and private institutions that provide services to the community

E. I have a greater understanding of the roles of other health professionals

F. I felt engaged in center operations and community events

G. Based on this clinical experience I am now considering working in a medically underserved area, rural area, or community health center

3. In what type of setting do you intend to practice?

Outpatient Primary Care

Inpatient Primary Care

Community Health Center

Other

4. Rate the probability of where you will practice upon completion of your education:

Not Probable
(1)

(2)

Somewhat
Probable
(3)

(4)

Highly
Probable
(5)

A) Arizona

B) Rural Area

C) Underserved /
Urban Area

5. What recommendations would you make to improve this rotation?