Please identify and discuss your learning goals for the clerkship with your preceptor by the end of week one. At mid-clerkship access your progress toward your goals and identify additional goals. Discuss additional goals with your current preceptor or your preceptor for the final four weeks of the clerkship. The final evaluation by your preceptor will address your progress towards your goals, the preceptor'(s) goals, and department goals. Issues to consider include:

1. Other clerkships/clinical experiences you have completed
2. Your medical interests
3. Your previous life experiences
4. Additional skills identified on the Clinical Skills Inventory form
5. Clerkship educational goals and objectives
6. Clerkship evaluation methods and forms
7. Roles for preceptor and student

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Preceptor goals: List two to five most important areas on which the student should focus, and strategies for addressing these areas.
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Your (student) summary of progress toward goals and expectations at mid- & end of clerkship. Review with preceptor and department faculty as an opportunity to discuss your progress.
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Preceptor's Signature / Date Student's Signature / Date

Adapted from "Learner Contracts", by Jeanne Ferrante, MD, Family Medicine, Vol 30, No 10, Nov-Dec, 1998.