TRAINEE FEEDBACK FORM FOR CLINIC STAFF
Clinic: ___________________________________ Date:______________
Name of Trainee: ____________________________________________
- Please rate the trainee on the following:
| a. Uses respectful/gender inclusive language free from medical jargon | Always | Usually | Rarely | Don’t know |
| b. Establishes rapport, demonstrates compassion | Always | Usually | Rarely | Don’t know |
| c. Explains procedures accurately | Always | Usually | Rarely | Don’t know |
| d. Answers patient questions accurately | Always | Usually | Rarely | Don’t know |
| e. Maintains patient confidentiality | Always | Usually | Rarely | Don’t know |
| f. Treats me and staff respectfully | Always | Usually | Rarely | Don’t know |
| g. Manages time effectively | Always | Usually | Rarely | Don’t know |
- What are this trainee’s strengths?
- How might this trainee provide better reproductive health services to our patients?