Student Evaluation of the Practicum Form

School of Public Health & Health Sciences

University of Massachusetts, Amherst

 

Name of Student: ______________________________________________________

Student’s Division/Department: _____________________

Dates of Practicum: From: _____________ To: ____________ Total Weeks: ____Hours/Wk ____

Name of Practicum Site Supervisor: ___________________________________________________

Practicum Site Supervisor’s Title: _____________________________________________________

Agency, Organization, or Company: ___________________________________________________

Address: _____________________________________________________________

Telephone Number: __________________

Fax Number: ___________________

E-mail Address: ___________________________________________

 

I. Please describe at least 5 competencies that you gained from your experience in the practicum using the following framework. Competencies are found at the end of this form:

 

 

Competency Area

Specific Competency

Activities in which you participated in order to achieve competencies in this area

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

II. Write a written report on the practicum. This report is limited to 10 double-spaced pages, preferably a 10 to 12 font, 1” margins, and should follow the structure outlined in Table 7. Please use either APA or AMA format to site references.

Table 7. Guidelines for Written Report as part of the Practicum Student Report

Below is a list of questions to assist you in writing your paper. While you do not have to answer each and every question, they are provided to generate ideas about the site and your experiences.

· Introduction: Describe the background illustrating the importance of your project and its context. How did you decide on your project?

· Methods: What were the goals and objectives you and your site supervisor agreed upon for your experience?

· Results/Outcomes: What did you do? Who were the people that you interacted with during your experience? What were their roles? Describe the best thing that happened during the experience – something you or someone else said or did, a feeling, insight gained, or goal accomplished.

· Lessons learned: What surprised you? What were your positive and negative experiences during the practicum? What did you learn that will enhance your classroom-based experiences? In what ways has this experience changed how you think about public health practice? What insights did you gain that might assist you in your career? What did the experience teach you about public health issues? What specific suggestions do you have that would have improved the project you worked on, the site itself or the experience?

 

 

III. Reflect on your experience in the practicum and indicate your judgment of the following on a scale of 1 (LOW) to 5 (HIGH) by circling the appropriate number next to each item. Circle NA for those items you do not feel qualified to evaluate or for those items that did not apply to this experience.

 

 

LOW

AVERAGE

HIGH

I was oriented to the site environment

1

2

3

4

5

NA

The site created an atmosphere of acceptance, friendliness and belonging.

1

2

3

4

5

NA

The Site Supervisor clarified my responsibilities.

1

2

3

4

5

NA

The Site Supervisor assisted in establishing goals and objectives for my practicum.

1

2

3

4

5

NA

The Site Supervisor demonstrated effective administrative methods and techniques.

1

2

3

4

5

NA

The Site Supervisor encouraged me to participate in departmental and/or program meetings.

1

2

3

4

5

NA

The Site Supervisor allowed me to take initiative and be creative.

1

2

3

4

5

NA

The Site Supervisor met with me at least weekly to discuss progress and/or problems.

1

2

3

4

5

NA

The Site Supervisor provided constructive criticism and guidance.

1

2

3

4

5

NA




The Site Supervisor served as an effective professional role model for me.

1

2

3

4

5

NA

Overall, how would you rate the learning experience you received?

1

2

3

4

5

NA

Overall, how would you rate your Site Supervisor?

1

2

3

4

5

NA

* Adapted from the University of Oklahoma Health Sciences Center

 

 

____Attach a copy of any work produced for the organization

 

Student Signature: _________________________________________Date: ________

 

SPHHS Practicum Coordinator Signature:___________________________ Date: _____________

 

Submit the completed form to the Worcester MPH Practicum Coordinator as indicated below. Sending it as an attachment to an email is welcomed.

 

Jackie Coghlin-Strom, MD, MPH
Dept of Family Medicine and Community Health
University of Massachusetts Medical School
55 Lake Ave North
Worcester MA 0165

Updated 08/16/12