External Learner Clinical Pre-Assessment

Instructions: Please respond to the below questions prior to your learning experience with Planned Parenthood. These will be shared with your clinical preceptor(s) and help us determine how best to meet your needs.

1. Learner Information *This question is required.

First Name

Last Name

Program/Residency

2. Tell us about your professional goals. *This question is required.

3. Describe your clinical rotations thus far. Types of rotations (primary or specialty care, reproductive health, contraceptive care, STIs etc.), preceptors, service mix:
*This question is required.

4. Approximate number of LARC (IUC, implant) procedures performed or N/A: *This question is required.

5. Comfort level performing pelvic/ bimanual exams:
*This question is required.

6. Comfort level performing reproductive health, contraceptive care, STI’s:
*This question is required.

7. What are some goals you would like to accomplish during your time with us? Examples might include gaining clinical experience with gynecologic care, birth control management, procedures, LGBTQ care. And/ or, improving time-management, patient communication or documentation skills.
*This question is required.

8. How best do you learn new skills (visual, auditory, observation, hands-on)?
*This question is required.

9. Is there anything else you would like us to know (special needs, requests)?
*This question is required.