Graduate Student Evaluation By Preceptor

Preceptor Name

Clinic Site

	CentraCare
	Children's Hospital
	CSB Health Center
	Essentia Health
	CHI St Gabriel's Little Falls
	Sanford Health
	Other

Student Name

Semester

Spring 2026

Course Description: The focus of this course will be the development of advanced practice skills as it relates to health promotion and disease prevention for clients within primary care. The student will learn how to use critical and diagnostic reasoning within the clinical setting to holistically assess, diagnose, manage and educate patients across the lifespan. Students will work with a faculty preceptor caring for patients in a clinical setting to use skills based on primary care delivery principles. Students will collaborate with the healthcare team, communicate and document the care of their patients under the supervision of their faculty preceptor. This course will focus on the care of a patient as it relates to physical, sociocultural, psychological, developmental, and spiritual aspects of life.

Pass = Meets expectations with moderate to minimal supervision

M = Meets Expectations
•Passing clinical performance demonstrates safe and adequate application of the
clinical competencies within a defined time frame. Clinical expectations are met
with moderate to minimal supervision.

NM = Not Meet Expectations
•Unable to meet expectations in clinical performance is defined as unsafe or inadequate in meeting competencies within a defined time frame and/or requires continuous verbal cues to function in the clinical setting, requires full supervision and/or does not demonstrate learning consistent with course objectives. Comments with recommendations are required.

*MID-SEMESTER:

*NI = Needs Improvement (only may be used at mid-semester evaluation)
•Clinical performance is not consistent in application of clinical course objectives within a defined time frame; requires occasional verbal or nonverbal cues to function in the clinical area and demonstrates learning inconsistent with course objectives. Please add comment(s). Faculty may need to meet with student for remediation plan.

*N.O.–Not observed(only be used at mid-semester evaluation)
•Not applicable, not seen, or unable to be assessed.

COMPETENCIES/EXPECTATIONS:

Scientific Foundation/Practice/Technology and Information Literacy Competencies

1.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Performs comprehensive organized history and physical examinations

Comments

2.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Elicits a periodic focused history and physical examinations

Comments

3.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Differentiates between normal and abnormal findings

Comments

4.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Assess individuals/populations served for socioeconomic, cultural, developmentally disabled, and unique needs, including use of interpreters as needed

Comments

5.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Identifies patient’s differential diagnoses

Comments

6.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Determines priorities of findings for intervention

Comments

7.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Develops a mutually acceptable plan of care

Comments

8.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Selects appropriate diagnostic testing

Comments

9.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Determines appropriate pharmacologic therapy

Comments

10.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Prescribes appropriate non-pharmacologic therapy

Comments

11.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Refers patients to appropriate community/institutional resources, planning for transitions across the continuum of care with appropriate inter-professional communication

Communication:

1.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Communicates practice knowledge effectively, both orally and in writing

Comments

2.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Provides education regarding current health problems, health promotion, and disease prevention at patient’s level of understanding

Comments

3.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Translates technical and scientific health information appropriate for various users’ needs

Comments

4.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Evaluates the outcomes of patient education

Comments

5.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Maintains confidentiality and privacy

Comments

Professional Role / Leadership

1.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Utilizes an evidence-based approach to care using current standards and technology systems

Comments

2.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Collaborates effectively with members of the health care team for productive teamwork across the professions

Comments

3.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Provides care recognizing professional limitations

Comments

4.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Accepts feedback and constructive criticism

Comments

5.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Demonstrates self-direction and uses problem-solving skills

Comments

6.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Utilizes time effectively and efficiently

Comments

7.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Cooperates with preceptor with initial planning of clinical hours

Comments

8.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Demonstrates the highest level of accountability for professional practice

Comments

Health Delivery System/ Quality Competencies

1.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Practices within scope of practice

Comments

2.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Identifies how situations related to access, cost, efficacy and quality influence care decisions

Comments

3.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Minimizes risk to patients and providers at the individual and systems level

Comments

4.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Anticipates variations in practice and is proactive in implementing interventions to ensure quality

Comments

Ethics Competencies

1.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Integrates ethical principles in decision making

Comments

2.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Provides patient-centered care recognizing cultural diversity and the patient or designee as a full partner in decision making

Comments

3.

	Mid- Semester Meets	Mid-Semester Needs Impr.	Mid- Semester Not-Observed	Final Meets-Exp	Final Not Meets
Provides culturally sensitive care

Comments

Additional Comments and Feedback:

Student Signature and Date

Preceptor Signature and Date

Faculty Signature and Date

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