College of Optometry


Externship Site Evaluation Form 4


Fields marked with an asterisk * are required.

Name of Site*
Attending Doctor*
Graduation Year
Extern email address*

Evaluation of Attending Doctor
Please select 1 for the lowest and 5 for the highest.
Basic attributes:
1. Is skilled in clinical techniques.
2. Is knowledgeable about alternative procedures and techniques.
3. Discusses recent developments in optometry when appropriate.
Rapport with students:
4. Presents facts and concepts about patient care decisions.
5. Emphasizes conceptual understanding.
6. Is friendly toward students.
7. Relates to students as individuals.
8. Approaches teaching and the externship program with enthusiasm.
9. Has an interest in student development as clinicians.
10. Invites students to share their knowledge and experiences.
11. Encourages student questions and discussion.
12. Helps students organize their thinking for problem solving.
13. Corrects student mistakes constructively.
14. Suggests specific ways a student can improve.
15. Tells students when they have done a particularly good job.
16. Consistently assesses student progress.
Rapport with patients:
17. Demonstrates sensitivity to the particular needs of patients.
18. Considers the social and psychological aspects of patient care.
19. Performs tests and procedures on patients when indicated.
20. Speaks directly to the patient about the assessment and management plan.
21. Maintains rapport with patients.

Evaluation of site
22. This site has met your externship rotation expectations.
23. The facilities were adequate for performing necessary tests and evaluations.
24. How would you rate this site for continued externship utilization?
25. Rate this site for level of student delivery of direct patient care [1] [10]
26. Did this site satisfy the expectations you had when you selected it? [1] [10]
27. A short comment is required on Question # 24. (Max. 800) * Characters left
28. What new optometric skills have you acquired? How have your optometric skills been enhanced at this rotation?(Max 999 characters) *
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29. The best piece of advice you would give to fellow students to help them prepare for this externship site(Max 999 characters) *  
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30.Comment on your 3-year academic preparation for this externship.Areas of curricular changes suggested.(Max 999 characters) *
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Questions? e-mail Alex Harris O.D., Director of Externship Programs (314-516-5603)
Questions? e-mail Yolanda Flanigan, Support Staff for Externship Programs (314-516-5606)

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Webmaster: Dr. Ralph Garzia & Sudhir Kumar Balusu
Last Updated: June -06 - 2013