Clinical Proctor Performance Evaluation
Please complete this form to evaluate the performance of the clinical proctor. Your feedback is valuable for quality improvement.
Evaluator's Full Name
*
First Name
Last Name
Evaluator's Position/Title
*
Evaluator's Email Address
*
example@example.com
Proctor's Full Name
*
First Name
Last Name
Proctor's Department or Specialty
*
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please rate the clinical proctor on the following criteria:
*
Rows
Poor
Fair
Good
Very Good
Excellent
Clinical knowledge and expertise
1
2
3
4
5
Teaching and mentoring skills
6
7
8
9
10
Professionalism and conduct
11
12
13
14
15
Communication with staff and learners
16
17
18
19
20
Adherence to protocols and procedures
21
22
23
24
25
Responsiveness to questions and concerns
26
27
28
29
30
Overall rating of the proctor's performance
*
1
2
3
4
5
Strengths observed during the proctoring session
Areas for improvement or recommendations
Would you recommend this proctor for future assignments?
*
Yes
No
With reservations
Evaluator's Signature (please sign below to confirm the accuracy of your evaluation)
*
Submit Evaluation
Submit Evaluation
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