TRAINEE FEEDBACK FORM FOR CLINIC STAFF

Clinic: ___________________________________ Date:______________

Name of Trainee: ____________________________________________

 

  1. Please rate the trainee on the following:
a. Uses respectful/gender inclusive language free from medical jargon Always Usually Rarely Don’t know
b. Establishes rapport, demonstrates compassion Always Usually Rarely Don’t know
c. Explains procedures accurately Always Usually Rarely Don’t know
d. Answers patient questions accurately Always Usually Rarely Don’t know
e. Maintains patient confidentiality Always Usually Rarely Don’t know
f. Treats me and staff respectfully Always Usually Rarely Don’t know
g. Manages time effectively Always Usually Rarely Don’t know

 

  1. What are this trainee’s strengths?

 

  1. How might this trainee provide better reproductive health services to our patients?




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TEACH Abortion Training Curriculum Copyright © 2022 by UCSF Bixby Center for Global Reproductive Health. All Rights Reserved.