**Evaluation of OVERALL Clinical Training program**

**(to be completed semiannually by Fellows)**

Name\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Training Program
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

# Educational Experience 

1\. Please rate the quality of the clinical training you received on NIH
rotations*.*

1 2 3 4 5

Unsatisfactory Satisfactory Outstanding

Comments:

2\. Please rate the quality of the didactic training you received on NIH
rotations.

1 2 3 4 5

Unsatisfactory Satisfactory Outstanding

Comments:

3\. Please rate the quality of the clinical training you received on
outside rotations.

1 2 3 4 5

Unsatisfactory Satisfactory Outstanding

Comments:

4.  Please rate the quality of the didactic training you received on
    outside rotations.

1 2 3 4 5

> Unsatisfactory Satisfactory Outstanding
>
> Comments:

5.  Please rate the quality of the consult services.

1 2 3 4 5

> Unsatisfactory Satisfactory Outstanding
>
> Comments:

6.  Are you given adequate time to attend conferences, rounds, etc?

1 2 3 4 5

> Unsatisfactory Satisfactory Outstanding
>
> Comments:
>
> 7\. Has the level of training met your expectations?

1 2 3 4 5

No Yes Exceeded

> Comments:
>
> 8\. What is your general level of satisfaction with the overall
> clinical training.

1 2 3 4 5

Not Satisfied Satisfied Very Satisfied

Comments:

> 9\. What is your general level of satisfaction with the overall
> didactic training.

1 2 3 4 5

Not Satisfied Satisfied Very Satisfied

Comments:

10\. What are the strengths of the training program?

> 11\. What are the weaknesses of the training program?

12. How could this training program be improved?

> 13\. Please list and rate the conferences, seminars, etc., which you
> have attended regularly.

(1= poor; 2 = fair; 3= good; 4 = very. good; 5 = outstanding).

+---------------------------------+------------+-----------+-----------+
| [Name]{.underline}              | [Fr        | Quality   | Relevance |
|                                 | equency]{. | of        | of        |
|                                 | underline} |           |           |
|                                 |            | ##        | ##        |
|                                 |            |  Teaching |  Material |
+---------------------------------+------------+-----------+-----------+
|                                 |            |           |           |
+---------------------------------+------------+-----------+-----------+
|                                 |            |           |           |
+---------------------------------+------------+-----------+-----------+
|                                 |            |           |           |
+---------------------------------+------------+-----------+-----------+
|                                 |            |           |           |
+---------------------------------+------------+-----------+-----------+

14\. Without accreditation, would you have applied to this program?

[Supervision]{.underline}

1\. Are you adequately supervised during NIH rotations?

1 2 3 4 5

Never Usually Always

Comments:

2\. Are you adequately supervised during outside rotations?

1 2 3 4 5

Never Usually Always

Comments:

3\. Are attendings available when needed by telephone or in person?

1 2 3 4 5

Never Usually Always

Comments:

[Evaluation]{.underline}

1\. Do you feel that you are evaluated fairly.

1 2 3 4 5

Never Usually Always

Comments:

2\. Do you receive a written evaluation after each rotation?

1 2 3 4 5

Never Usually Always

Comments:

3\. Do you receive a written evaluation semiannually from the program
director?

1 2 3 4 5

Never Usually Always

Comments:

4\. Are you given an opportunity to evaluate the clinical teaching
faculty?

1 2 3 4 5

Never Usually Always

Comments:

[Additional Comments:]{.underline}