Clinical Supervisors: SELF ASSESSMENT FORM
Maastricht Clinical Teaching Questionnaire1
This is a TWO sided form.
Name:________________
Date: _________________
Years of specialist practice: ¨ 0-4 ¨ 5- 9 ¨ 10-14 ¨14+
Primary practice location:
Previous experience in clinical supervision/teaching development:
¨ None
¨ Basic professional development: workshops/training < 20 hours in total
¨ Advanced professional development: workshops/training >= 20 hours in total
¨ Qualification (e.g. CERT IV, Masters of Nursing Education, Graduate Certificate of Health Professional Education)
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Please indicate your level of agreement with the following statements: |
Fully Fully Disagree Agree |
Unable to comment |
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| 1. I consistently demonstrate how to perform clinical tasks |
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| 2. I clearly explain the important element for the execution of a given task |
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| 3. I create sufficient opportunity for the student to observe me |
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| 4. I serve as a role model as to the kind of health professional students would like to become |
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| 5. I observe students multiple times during patient encounters |
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| 6. I give useful feedback during or immediately after direct observation of the student’s patient encounters |
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| 7. I help the student understand which aspects they need to improve |
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| 8. I adjust my teaching activities to the level of experience of students |
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| 9. I offer sufficient opportunities to students to perform activities independently |
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| 10. I support students in activities that they find difficult to perform |
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| 11. I gradually reduce the support given to allow students to perform certain activities more independently |
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Please indicate your level of agreement with the following statements: |
Fully Fully Disagree Agree
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Unable to comment |
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| 12. I ask students to provide a rationale for their actions |
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| 13. I help students become aware of gaps in their knowledge and skills |
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| 14. I ask students questions aimed at increasing their understanding |
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| 15. I encourage students to ask me questions to increase their understanding |
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| 16. I stimulate students to explore their strengths and weaknesses |
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| 17. I stimulate students to consider how they could improve their strengths and weaknesses |
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| 18. I encourage students to formulate learning goals |
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| 19. I encourage students to pursue their learning goals |
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| 20. I encourage students to learn new things |
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| 21. I create a safe learning environment |
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| 22. I take sufficient time to supervise students |
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| 23. I am genuinely interested in the students |
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| 24. I show respect to students |
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Rate yourself on an overall assessment (1 – 10) of your own clinical supervision performance (10=excellent):
_______/10
What are your strengths as a clinical supervisor?
What areas would you like to improve on as a clinical supervisor?
1Stalmeijer R, Dolmans D, Wolfhagen I, et al. 2010. Combined student ratings and self-assessment provide useful feedback for clinical teachers. Advances in Health Sciences Education 15(3) 315-28.
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