Professional Development Evaluation Form

DEPARTMENT OF PHYSICIAN ASSISTANT STUDIES PROFESSIONAL DEVELOPMENT EVALUATION FORM

Student: __________________________ Faculty member: ____________________ Date: _____________________________

ATTRIBUTE UNSATISFACTORY (0)

NEEDS IMPROVEMENT (1) MEETS REQUIREMENTS (2)

EXCEEDS REQUIREMENTS (3)

Respects faculty and classmates by arriving punctually Notifies faculty if circumstances prevent attendance; satisfactorily makes up missed assignments Assumes responsibility for own action Demonstrates ability to solve problems by logically evaluating facts Demonstrates ability to be flexible with unexpected circumstances Demonstrates functional level of confidence and selfassurance

ATTRIBUTE UNSATISFACTORY (0)

NEEDS IMPROVEMENT (1) MEETS REQUIREMENTS (2)

EXCEEDS REQUIREMENTS (3)

Demonstrates ability to be a cooperative and contributing member of the class and profession Recognizes and manages personal and professional frustration in a nondisruptive and constructive manner Demonstrates ability to modify behavior in response to constructive criticism

Demonstrates ability to give constructive feedback Respects fellow students, staff, and faculty Demonstrates proper respect for patients and maintains confidentiality of medical information

Additional comments by faculty or student (optional):

_______________________________________ _______________________________ Student signature Faculty advisor’s signature