Multisource Feedback for Clinical Supervisors: STUDENT FORM
Maastricht Clinical Teaching Questionnaire1
This is a TWO sided form. All responses will be collated and returned to the clinical supervisor.
Clinical Supervisor’s Surname: ____________________
First name: _____________________
Date: _________________
Health profession you are studying (e.g. nursing, physiotherapy, medicine etc): _______________
Your year of study: ________________
Length of time you have worked with this clinical educator: ____________ (indicate days or weeks or months)
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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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This clinical supervisor: |
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1. consistently demonstrated how different tasks should be performed |
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| 2. clearly explained the important elements for the execution of a given task |
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3. created sufficient opportunities for me to observe them. |
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4. was a role model as to the kind of health professional I wish to become |
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This clinical supervisor: |
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5. observed me multiple times during patient encounters |
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6. provided me with useful feedback during or following direct observation of patient encounters |
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| 7. helped me understand which aspects I needed to improve |
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This clinical supervisor: |
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| 8. Adjusted teaching activities to my level of experience |
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| 9. Offered me sufficient opportunities to perform activities independently |
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| 10. Supported me in activities I find difficult to perform |
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| 11. Gradually reduced the support given to allow me to perform certain activities more independently |
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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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This clinical supervisor: |
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| 12. Asked me to provide a rationale for my actions |
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| 13. Helped me to become aware of gaps in my knowledge and skills |
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| 14. Asked me questions aimed at increasing my understanding |
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| 15. Encouraged me to ask questions to increase my understanding |
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This clinical supervisor: |
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| 16. Stimulated me to explore my strengths and weaknesses |
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| 17. Stimulated me to consider how I might improve my strengths and weaknesses |
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This clinical supervisor: |
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| 18. Encouraged me to formulate learning goals. |
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| 19. Encouraged me to pursue my learning goals. |
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| 20. Encouraged me to learn new things. |
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This clinical supervisor: |
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| 21. Created a safe learning environment. |
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| 22. Took sufficient time to supervise me. |
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| 23. Was genuinely interested in me as a student. |
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| 24. Showed me respect. |
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Overall, give this clinical supervisor an overall assessment (1 – 10) of their clinical teaching performance (10 =excellent):
_______/10
What are the strengths of this clinical supervisor?
Which aspects of the performance of this clinical supervisor can be improved?
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.
