Narm Quarterly Evaluation Form Page 3

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NARM Quarterly Evaluation Form
Preceptor’s Name: ______________________________________________________________________
Apprentice’s Name: _____________________________________________________________________
Time period covered by evaluation: _________________________________________________________
Discussion Questions:
Notes may be taken on a separate sheet of paper.
1. Have clear goals been outlined, such as educational goals and expected rate of progress?
2. Do the preceptor and apprentice meet outside of clinical time to discuss progress, evaluation of
performance and knowledge? Has the meeting time allowed for adequate discussion?
3. Is the apprentice provided with an opportunity to progress in increasing levels of skills and
responsibilities? If not, what are the possible impediments?
4. Is the apprentice demonstrating adequate self-study skills, including application of new knowledge in a
clinical setting?
5. Is the apprentice progressing through the Assistant Under Supervision clinicals in increasing levels of
responsibility? Will the apprentice be prepared to move into a primary role upon meeting the minimum
requirements, or should s/he continue to train in an assistant role?
6. Are expectations being met for both preceptor and apprentice? If not, what are the areas requiring more
focus?
Additional topics of discussion: ____________________________________________________________
Clinical Experience
Number Attended
Number Initialed on CPM Application
Observed Births
Births as an Assistant
Initial Prenatals as an Assistant
Prenatals as an Assistant
Newborn Exams as an Assistant
Postpartum Exams as an Assistant
Births as a Primary
Continuity of Care Births as a Primary
Primary Births with at least 1 Prenatal
Initial Prenatals as a Primary
Prenatals as a Primary
Newborn Exams as a Primary
Postpartum Exams as a Primary
____________________________________________________
__________________
Preceptor Signature
Date
____________________________________________________
__________________
Apprentice Signature
Date
20
NARM Preceptor Handbook
September 2014

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