TRAINEE FEEDBACK FORM FOR CLINIC STAFF
Clinic: ___________________________________ Date:_____________
Name of Trainee: ____________________________________________
- Please rate the trainee on the following:
| Never | Seldom | Sometimes | Often | Always | Not observed | |
| Uses respectful, trauma-responsive, and gender inclusive language free from medical jargon | ||||||
| Establishes rapport, demonstrates compassion | ||||||
| Explains procedures accurately | ||||||
| Answers patient questions accurately | ||||||
| Maintains patient confidentiality | ||||||
| Treats me and staff respectfully | ||||||
| Manages time effectively |
- What are this trainee’s strengths?
- How might this trainee provide better reproductive health services to our patients?