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ROME Learner Contract

Review topics for preceptor and student:

_____A. Student previous clinical experiences

_____B. Student medical interests

_____C. Clinical skills inventory form

_____D. Clerkship educational goals and objectives

_____E. Clerkship evaluation forms

_____F. Roles for preceptor and student

_____G. Evaluation methods

Learning Objectives

Student goals (to be completed after first full day in preceptor’s office)

List two to five learning objectives and specific strategies for accomplishing them.

Preceptor goals (to be completed by the end of the first week)

List two to five most important areas on which the student should focus and strategies for addressing these areas.

Agreement on goals (to be completed by the end of the first week)

Student’ s summary of performance goals and expectations.

_____________________________ ____________________________
Preceptor’s Signature/Date Student’s Signature/Date

Adapted from the Preceptor Education Project. Kansas City, Mo: Society of Teachers of Family Medicine, 1992 and from “Learner Contracts”, by Jeanne Ferrante, MD, Family Medicine, Vol 30, No 10, Nov-Dec, 1998.






 
 
 
 
 
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University of North Dakota
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Department of Family Medicine
School of Medicine & Health Sciences
PO Box 9037, Grand Forks, ND 58202
TELEPHONE 701-777-3200
FAX 701-777-3200
EMAIL family@medicine.nodak.edu