60
Gardner-Webb Athletic Training
Athletic Training Observation Student Evaluation
Name:_______________________________ Preceptor:_____________________________ Semester/Year:____________ Date:___________
Please rate the above student in the following area in regards to his/her performance during the assigned rotation. Please use the following scale in your evaluation.
5 - Superior 4 - Good 3 - Average 2 - Fair 1 - Unacceptable
Attendance:
Student scheduled times appropriately and in a timely manner 5 4 3 2 1 N/A Student was punctual and showed up for assigned times and activities 5 4 3 2 1 N/A Initiative:
Student sought out unknown information 5 4 3 2 1 N/A
Student demonstrated engagement in experience through active observation 5 4 3 2 1 N/A Interest:
Shows interest in learning environment through appropriate conversation 5 4 3 2 1 N/A Shows interest in athletic training profession through conversation and preparedness 5 4 3 2 1 N/A
Professionalism:
Student was receptive to instruction and/or feedback 5 4 3 2 1 N/A
Student demeanor reflects well on the profession during interactions with Preceptors, 5 4 3 2 1 N/A ATSs, patients, coaches, and medical personnel
Strengths:
Things to work on:
Preceptor: ___________________________________________________ Date: _____________________ ATS: ______________________________________________________ Date: _____________________
59
Gardner-Webb Athletic Training
Sophomore Level Major and Mini Clinical Experience Evaluation
Name: ______________________ Clinical Experience: _______________ Date: ___________ Type of experience: □ Major □ Mini Timing of evaluation: □ Mid □ End
Filled out by: □ Preceptor □ ATS
Please rate the above student in the following areas in regards to his/her performance during the assigned rotation. Please note that a 3 is what the average athletic training student is expected to achieve. A score of 3 is not to be viewed as negative, but rather seen as an area where improvement can be made. An athletic training student who is demonstrating skills at a higher level will earn a 4 or 5 which results in a higher grade. Please utilize the following Leichert grading scale in your responses.
5 – Excellent 4 – Above Average 3 – Average 2 – Below Average 1 – Unsatisfactory N/A – Not Applicable
Athletic Training Clinical Skills:
1. Properly fits protective equipment with verbal cueing and physical assistance 5 4 3 2 1 N/A 2. Properly applies basic taping, wrapping, and/or padding principles with verbal 5 4 3 2 1 N/A
cueing and physical assistance
3. Properly obtains and relays information regarding environmental conditions 5 4 3 2 1 N/A 4. Properly obtains basic information regarding medical history 5 4 3 2 1 N/A 5. Demonstrates ability to observe and interact when appropriate during observations 5 4 3 2 1 N/A
and palpations for injuries/illnesses
6. Demonstrates ability to observe and interact when appropriate during range of 5 4 3 2 1 N/A motion and manual muscle testing procedures
7. Demonstrates ability to observe and interact when appropriate during special tests 5 4 3 2 1 N/A 8. Demonstrates ability to observe and interject when appropriate during diagnosis of 5 4 3 2 1 N/A
injuries/illnesses
9. Properly applies appropriate management strategies for emergency situations 5 4 3 2 1 N/A 10. Properly applies therapeutic modalities with verbal cueing and physical assistance 5 4 3 2 1 N/A 11. Properly selects and applies OSHA guidelines in management of blood, body fluids, 5 4 3 2 1 N/A
and medical waste safely and independently
Professional Attributes:
12. Properly recognizes the necessity for primacy of the patient 5 4 3 2 1 N/A 13. Properly recognizes the need to work well as a team member within the sports 5 4 3 2 1 N/A
medicine team (ATS, ATC, MD, Coach, Family, etc)
14. Demonstrates ability to understand the professional code of ethics and legal 5 4 3 2 1 N/A standards
15. Demonstrates ability to recognize and respect cultural differences 5 4 3 2 1 N/A 16. Demonstrates ability to act and treat others in a dignified and respectable 5 4 3 2 1 N/A
manner of professionalism
17. Demonstrates a willingness to learn and apply new skills 5 4 3 2 1 N/A 18. Demonstrates reliability and dependability 5 4 3 2 1 N/A 19. Accepts constructive criticism and sets goals based on feedback from Preceptor 5 4 3 2 1 N/A
20. Demonstrates critical thinking skills 5 4 3 2 1 N/A
21. Demonstrates adaptability and cooperation 5 4 3 2 1 N/A
Comments: (Please explain any rating given a 2 and below)
__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
60
Please fill out the total points, percentage and numerical grade for major clinical experiences only.
Total points for evaluation ______ / ______ total items = ______ average score for evaluation Utilizing the table below please provide numerical grade: ______
Average Score Grade Equivalent Average Score Grade Equivalent
4.46-5.0 94.6-100%A 2.66-3.05 76.6-80.5% C 4.16-4.5 91.6-94.5% A- 2.36-2.65 73.6-76.5% C- 3.96-4.15 89.6-91.5% B+ 2.16-2.35 71.6-73.5%D+ 3.56-3.95 85.6-89.5% B 1.76-2.15 67.6-71.5 D 3.26-3. 55 82.6-85.5 % B- 1.46-1.75 64.6-67.5% D- 3.06-3.25 80.6-82.5%C+ 0.0-1.45 0-64.0 % F Strengths: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
Things to work on:
__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ ATS comments: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Preceptor: ___________________________________________________ Date: _____________________ ATS: ______________________________________________________ Date: _____________________
62
Gardner-Webb Athletic Training
Junior Level Major and Mini Clinical Experience Evaluation
Name: ______________________ Clinical Experience: _______________ Date:
___________
Type of experience: □ Major □ Mini Timing of evaluation: □ Mid □ End Filled out by: □ Preceptor □ ATS
Please rate the above student in the following areas in regards to his/her performance during the assigned rotation. Please note that a 3 is what the average athletic training student is expected to achieve. A score of 3 is not to be viewed as negative, but rather seen as an area where improvement can be made. An athletic training student who is demonstrating skills at a higher level will earn a 4 or 5 which results in a higher grade. Please utilize the following Leichert grading scale in your
responses.
5 – Excellent 4 – Above Average 3 – Average 2 – Below Average 1 – Unsatisfactory
Athletic Training Clinical Skills:
1. Properly selects and fits protective equipment with verbal cueing 5 4 3 2 1 N/A 2. Properly selects and applies taping, wrapping, and/or padding with verbal cueing 5 4 3 2 1 N/A
for appropriate adaptations dependent on patient needs
3. Properly obtains and interprets information regarding environmental conditions 5 4 3 2 1 N/A with assistance regarding appropriate decisions
4. Demonstrates ability to ask useful questions regarding medical history 5 4 3 2 1 N/A 5. Demonstrates ability to perform appropriate observations and palpations for 5 4 3 2 1 N/A
injuries/illnesses with verbal cueing
6. Demonstrates ability to perform appropriate range of motion and manual muscle 5 4 3 2 1 N/A testing procedures with verbal cueing
7. Demonstrates ability to perform appropriate special tests with verbal cueing 5 4 3 2 1 N/A 8. Demonstrates ability to properly diagnose common injuries/illnesses with assistance 5 4 3 2 1 N/A 9. Demonstrates ability to recognize and apply appropriate management strategies for 5 4 3 2 1 N/A
emergency situations with minimal assistance
10. Demonstrates ability to adhere to indications, contraindications, and precautions for 5 4 3 2 1 N/A therapeutic modalities with verbal cueing
11. Demonstrates ability to properly select and apply therapeutic modalities with 5 4 3 2 1 N/A verbal cueing
12. Demonstrates ability to adhere to indications, contraindications, and precautions for 5 4 3 2 1 N/A therapeutic exercises with verbal cueing
13. Demonstrates ability to properly select and apply therapeutic exercises with 5 4 3 2 1 N/A verbal cueing
14. Properly selects and performs functional assessments and fitness testing 5 4 3 2 1 N/A for safe participation and return to activity with verbal cueing
15. Properly selects and demonstrates OSHA guidelines in management of 5 4 3 2 1 N/A blood, body fluids, and medical waste safely and independently
16. Properly documents diagnosis of injuries, illness, treatments, and therapeutic exercise 5 4 3 2 1 N/A including progressions and goals with verbal cueing
17. Properly recognizes information necessary for completing the patient-file 5 4 3 2 1 N/A management system (Insurance, PPEs, HIPPA, etc) with verbal cueing
Professional Attributes:
18. Demonstrates ability to provide for primacy of the patient with verbal cueing 5 4 3 2 1 N/A 19. Demonstrates ability to work as a team member within the sports medicine team 5 4 3 2 1 N/A
(ATS, ATC, MD, Coach, Family, etc) with guidance from Preceptor
20. Demonstrates ability to recognize and act in accordance to the professional code of 5 4 3 2 1 N/A ethics and legal standards with guidance from Preceptor
62
21. Demonstrates ability to recognize and respect cultural differences 5 4 3 2 1 N/A 22. Demonstrates ability to act and treat others in a dignified and respectable 5 4 3 2 1 N/A
manner of professionalism
23. Demonstrates initiative and work ethic by completing daily athletic training room tasks 5 4 3 2 1 N/A 24. Demonstrates reliability and dependability 5 4 3 2 1 N/A 25. Accepts constructive criticism and makes changes when appropriate 5 4 3 2 1 N/A
26. Demonstrates critical thinking skills 5 4 3 2 1 N/A
27. Demonstrates adaptability and cooperation 5 4 3 2 1 N/A
Comments: (Please explain any rating given a 2 and below)
__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
Please fill out the total points, percentage and numerical grade for major clinical experiences only.
Total points for evaluation ______ / ______ total items = ______ average score for evaluation Utilizing the table below please provide numerical grade: ______
Average Score Grade Equivalent Average Score Grade Equivalent
4.46-5.0 94.6-100%A 2.66-3.05 76.6-80.5% C 4.16-4.5 91.6-94.5% A- 2.36-2.65 73.6-76.5% C- 3.96-4.15 89.6-91.5% B+ 2.16-2.35 71.6-73.5%D+ 3.56-3.95 85.6-89.5% B 1.76-2.15 67.6-71.5 D 3.26-3. 55 82.6-85.5 % B- 1.46-1.75 64.6-67.5% D- 3.06-3.25 80.6-82.5%C+ 0.0-1.45 0-64.0 % F Strengths: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
Things to work on:
__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ ATS comments: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Preceptor: ___________________________________________________ Date: _____________________ ATS: ______________________________________________________ Date: _____________________
63
Gardner-Webb Athletic Training
Senior Level Major and Mini Clinical Experience Evaluation
Name: ______________________ Clinical Experience: _______________ Date:
___________
Type of experience: □ Major □ Mini Timing of evaluation: □ Mid □ End Filled out by: □ Preceptor □ ATS
Please rate the above student in the following areas in regards to his/her performance during the assigned rotation. Please note that a 3 is what the average athletic training student is expected to achieve. A score of 3 is not to be viewed as negative, but rather seen as an area where improvement can be made. An athletic training student who is demonstrating skills at a higher level will earn a 4 or 5 which results in a higher grade. Please utilize the following Leichert grading scale in your
responses.
5 – Excellent 4 – Above Average 3 – Average 2 – Below Average 1 – Unsatisfactory
Athletic Training Clinical Skills:
1. Properly selects and fits protective equipment safely and independently 5 4 3 2 1 N/A 2. Properly selects and applies taping, wrapping, and/or padding safely and 5 4 3 2 1 N/A
independently adapting to individual patient needs
3. Properly obtains, interprets, and makes decisions regarding environmental conditions 5 4 3 2 1 N/A 4. Demonstrates ability to obtain a thorough medical history 5 4 3 2 1 N/A 5. Demonstrates ability to perform appropriate observations and palpations for 5 4 3 2 1 N/A
injuries/illnesses safely and independently
6. Demonstrates ability to perform appropriate range of motion and manual muscle 5 4 3 2 1 N/A testing procedures safely and independently
7. Demonstrates ability to perform appropriate special tests safely and independently 5 4 3 2 1 N/A 8. Demonstrates ability to properly diagnose common injuries/illnesses independently 5 4 3 2 1 N/A 9. Demonstrates ability to recognize and apply appropriate management strategies for 5 4 3 2 1 N/A
emergency situations safely and independently
10. Demonstrates ability to adhere to indications, contraindications, and precautions for 5 4 3 2 1 N/A therapeutic modalities safely and independently
11. Demonstrates ability to properly select and apply therapeutic modalities safely 5 4 3 2 1 N/A and independently
12. Demonstrates ability to adhere to indications, contraindications, and precautions for 5 4 3 2 1 N/A therapeutic exercises safely and independently
13. Demonstrates ability to properly select and apply therapeutic exercises safely 5 4 3 2 1 N/A and independently
14. Properly selects and performs functional assessments and fitness testing 5 4 3 2 1 N/A for safe participation and return to activity safely and independently
15. Properly selects and demonstrates OSHA guidelines in management of 5 4 3 2 1 N/A blood, body fluids, and medical waste safely and independently
16. Properly documents diagnosis of injuries, illness, treatments, and therapeutic exercise 5 4 3 2 1 N/A including progressions and goals safely and independently
17. Properly recognizes information necessary for completing the patient-file 5 4 3 2 1 N/A management system (Insurance, PPEs, HIPPA, etc) safely and independently
Professional Attributes:
18. Demonstrates ability to provide for primacy of the patient safely and independently 5 4 3 2 1 N/A 19. Demonstrates ability to work as a team member within the sports medicine team 5 4 3 2 1 N/A
(ATS, ATC, MD, Coach, Family, etc)
20. Demonstrates ability to recognize and act in accordance to the professional code of 5 4 3 2 1 N/A ethics and legal standards
64
22. Demonstrates ability to act and treat others in a dignified and respectable 5 4 3 2 1 N/A manner of professionalism
23. Demonstrates initiative and work ethic 5 4 3 2 1 N/A 24. Demonstrates reliability and dependability 5 4 3 2 1 N/A 25. Seeks and accepts constructive criticism and makes changes when appropriate 5 4 3 2 1 N/A
26. Demonstrates critical thinking skills 5 4 3 2 1 N/A
27. Demonstrates adaptability and cooperation 5 4 3 2 1 N/A
Comments: (Please explain any rating given a 2 and below)
__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
Please fill out the total points, percentage and numerical grade for major clinical experiences only.
Total points for evaluation ______ / ______ total items = ______ average score for evaluation Utilizing the table below please provide numerical grade: ______
Average Score Grade Equivalent Average Score Grade Equivalent
4.46-5.0 94.6-100%A 2.66-3.05 76.6-80.5% C 4.16-4.5 91.6-94.5% A- 2.36-2.65 73.6-76.5% C- 3.96-4.15 89.6-91.5% B+ 2.16-2.35 71.6-73.5%D+ 3.56-3.95 85.6-89.5% B 1.76-2.15 67.6-71.5 D 3.26-3. 55 82.6-85.5 % B- 1.46-1.75 64.6-67.5% D- 3.06-3.25 80.6-82.5%C+ 0.0-1.45 0-64.0 % F Strengths: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
Things to work on:
__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ ATS comments: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Preceptor: ___________________________________________________ Date: _____________________ ATS: ______________________________________________________ Date: _____________________
65
Gardner-Webb Athletic Training Affiliate Site Clinical Experience Evaluation
Name:____________________________ Clinical Experience:___________________________ Preceptor:___________________________ Semester/Year:____________ Date:___________ Filled out by: ATS Preceptor
Please rate the above student in the following area in regards to his/her performance during the assigned rotation. Please use the following scale in your evaluation.
5 - Excellent 4 – Above Average 3 - Average 2 – Below Average 1 - Unsatisfactory Attendance:
Student scheduled times appropriately and completed appropriate number of hours 5 4 3 2 1 N/A Student was punctual and showed up for assigned times and activities 5 4 3 2 1 N/A Quality of Work:
Carried out assigned tasks with detail and efficient 5 4 3 2 1 N/A Takes safety precautions without need and constant instruction 5 4 3 2 1 N/A Student was dependable when carrying out tasks 5 4 3 2 1 N/A Initiative:
Student was ambitious, sought out and performed task without being told 5 4 3 2 1 N/A
Student sought out unknown information 5 4 3 2 1 N/A
Student made intelligent observations and asked questions in a timely manner 5 4 3 2 1 N/A Student was cooperative and demonstrated self-confidence 5 4 3 2 1 N/A Interest:
Shows interest in patient 5 4 3 2 1 N/A
Demonstrates a positive, enthusiastic and involved attitude 5 4 3 2 1 N/A Shows interest in AT profession through conversation and preparedness 5 4 3 2 1 N/A Professionalism:
Dressed appropriately 5 4 3 2 1 N/A
Interacts with Preceptor, ATS, patient, coaches, and other medical personnel 5 4 3 2 1 N/A appropriately
Actions reflect well on profession 5 4 3 2 1 N/A
Strengths:
Things to work on:
ATS Signature: ___________________________ Preceptor Signature:_____________________________
66
Gardner-Webb Athletic Training Observation Student Preceptor Evaluation
Preceptor: ______________________________ Semester/Year: _______________ Date: _____________
Please evaluate your Preceptor by answering the questions below. Please give your honest feedback. Your information will remain anonymous; general comments will be shared periodically throughout the year with the supervisor to assist them in improving their teaching methods.
Using a 5-point scale, please indicate your perception of having received an adequate observation experience in the following areas. Please use the area marked for comments to explain any response given below a “3”. 5 = Excellent 4 = Above Average 3 = Average 2 = Below Average 1 = Unsatisfactory N/A = Not Applicable
Personal & Professional Attributes
Demonstrates passion for his/her work to athletic training students 5 4 3 2 1 N/A
Keeps athletic training students motivated 5 4 3 2 1 N/A
Respects athletic training students 5 4 3 2 1 N/A
Is a positive professional role model for students 5 4 3 2 1 N/A Demonstrates self-confidence as a professional 5 4 3 2 1 N/A Cares about student learning in the clinical setting 5 4 3 2 1 N/A Verbally and actively promotes the athletic training profession 5 4 3 2 1 N/A
Demonstrates patience and tactfulness 5 4 3 2 1 N/A
Demonstrates punctuality and reliability 5 4 3 2 1 N/A
Please explain any rating of 2 or below: _________________________________________________________ __________________________________________________________________________________________
Communication Skills
Provides feedback to students in timely ways 5 4 3 2 1 N/A Corrects students tactfully in an appropriate location/place 5 4 3 2 1 N/A
Actively engages students in conversation 5 4 3 2 1 N/A
States clear expectations for the students to follow 5 4 3 2 1 N/A Is approachable and accessible for the student to meet with 5 4 3 2 1 N/A Provides a clear orientation at the beginning of the 5 4 3 2 1 N/A observation experience
Provides on-going communication for student expectations 5 4 3 2 1 N/A
Is an active listener 5 4 3 2 1 N/A
Demonstrates rapport with the athletic training staff, doctors, 5 4 3 2 1 N/A and other medical staff
Demonstrates rapport with the coaches 5 4 3 2 1 N/A
Communicates schedule changes in a timely fashion, including 5 4 3 2 1 N/A arrangements for alternate student supervision
Please explain any rating of 2 or below: _________________________________________________________ __________________________________________________________________________________________
67
Teaching Abilities & Attitudes
Ability to explain concepts and clinical skills clearly 5 4 3 2 1 N/A
Provides daily direction and supervision 5 4 3 2 1 N/A
Provides a variety of learning opportunities 5 4 3 2 1 N/A
Discusses site policies and procedures 5 4 3 2 1 N/A
Involves students in the evaluation, treatment, and care of 5 4 3 2 1 N/A injured athletes
Discusses proper rehabilitation techniques and rationale for use 5 4 3 2 1 N/A Discusses proper therapeutic modalities use and rationale 5 4 3 2 1 N/A
Please explain any rating of 2 or below: _________________________________________________________ __________________________________________________________________________________________
1. Please identify the major strengths of the Preceptor:
2. Please identify any weaknesses of the Preceptor:
68
Gardner-Webb Athletic Training Preceptor and Clinical Site Evaluation
Preceptor: ________________________________ Clinical Site: ___________________________ Semester/Year: __________________ Date: _____________
Please evaluate your Preceptor by answering the questions below. Please give your honest feedback. Your information will remain anonymous; general comments will be shared, at the end of the year, with the supervisor to assist them in improving their clinical site and teaching methods.
Using a 5-point scale, please indicate your perception of having received an adequate clinical experience in the following areas. Please use the area marked for comments to explain any response given below a “3”.
5 = Excellent 4 = Above Average 3 = Average 2 = Below Average 1 = Unsatisfactory N/A = Not Applicable
Personal & Professional Attributes
Assists students in understanding their professional responsibility 5 4 3 2 1 N/A Acts according to the professional code of ethics and standards 5 4 3 2 1 N/A
Dresses professionally for work 5 4 3 2 1 N/A
Encourages students to dress professionally 5 4 3 2 1 N/A
Is open to new opportunities 5 4 3 2 1 N/A
Demonstrates passion for his/her work to athletic training students 5 4 3 2 1 N/A
Keeps athletic training students motivated 5 4 3 2 1 N/A
Respects athletic training students 5 4 3 2 1 N/A
Is a positive professional role model for students 5 4 3 2 1 N/A Demonstrates self-confidence as a professional 5 4 3 2 1 N/A Verbally and actively promotes the athletic training profession 5 4 3 2 1 N/A
Demonstrates patience and tactfulness 5 4 3 2 1 N/A
Demonstrates punctuality and reliability 5 4 3 2 1 N/A
Please explain any rating of 2 or below: _________________________________________________________ __________________________________________________________________________________________
Teaching Abilities & Attitudes
Cares about student learning in the clinical setting 5 4 3 2 1 N/A Promotes critical thinking skills in his/her teaching 5 4 3 2 1 N/A Combines academic knowledge with clinical practice 5 4 3 2 1 N/A Keeps up with current information within athletic training 5 4 3 2 1 N/A Ability to explain concepts and clinical skills clearly 5 4 3 2 1 N/A
Provides daily direction and supervision 5 4 3 2 1 N/A
Challenges athletic training students to broaden application of 5 4 3 2 1 N/A clinical skills
Provides a variety of learning opportunities 5 4 3 2 1 N/A Provides challenging scenarios for learning situations 5 4 3 2 1 N/A Involves students in the evaluation, treatment, and care of 5 4 3 2 1 N/A injured athletes
Discusses proper rehabilitation techniques and rationale for use 5 4 3 2 1 N/A Discusses proper therapeutic modalities use and rationale 5 4 3 2 1 N/A Provides opportunity for supervised autonomy 5 4 3 2 1 N/A Please explain any rating of 2 or below: _________________________________________________________ __________________________________________________________________________________________
69
Communication Skills
Provides feedback to students in timely ways 5 4 3 2 1 N/A Corrects students tactfully in an appropriate location/place 5 4 3 2 1 N/A Deals with conflict in a mature/professional manner 5 4 3 2 1 N/A Actively engages the students in conversation 5 4 3 2 1 N/A States clear expectations for the students to follow 5 4 3 2 1 N/A Is approachable and accessible for the student to meet with 5 4 3 2 1 N/A
Discusses site policies and procedures 5 4 3 2 1 N/A
Provides a clear orientation at the beginning of the clinical experience 5 4 3 2 1 N/A Provides on-going communication for student expectations 5 4 3 2 1 N/A
Is an active listener 5 4 3 2 1 N/A
Demonstrates rapport with the athletic training staff, doctors, 5 4 3 2 1 N/A and other medical staff
Demonstrates rapport with the coaches 5 4 3 2 1 N/A
Is physically present and able to intervene on behalf of the student 5 4 3 2 1 N/A during the duration of the clinical experience
Communicates schedule changes in a timely fashion, including 5 4 3 2 1 N/A arrangements for alternate student supervision
Please explain any rating of 2 or below: _________________________________________________________ __________________________________________________________________________________________
Clinical Setting
Provides a stimulating learning environment 5 4 3 2 1 N/A
Provides a positive education environment 5 4 3 2 1 N/A
Met my expectations 5 4 3 2 1 N/A
Provides exposure to a variety of clinical problems 5 4 3 2 1 N/A Helps in developing good professional work habits 5 4 3 2 1 N/A The supplies and equipment were adequate for this environment 5 4 3 2 1 N/A The experience assists in reinforcing the information and skills learned 5 4 3 2 1 N/A in prior course work
Proper OSHA guidelines in the management of blood, bodily fluids, 5 4 3 2 1 N/A and medical waste are used
Prescribed guidelines of the governing body for patient care (NCAA, 5 4 3 2 1 N/A NCHSAA, APTA, etc) are demonstrated
Please explain any rating of 2 or below: _________________________________________________________ __________________________________________________________________________________________
1. Overall rating of clinical setting: _____
5 = Excellent, 4 = Above Average, 3 = Average, 2 = Average, 1 = Unsatisfactory 2. Should the AT Program continue to utilize this clinical setting: Yes No 3. Please identify the major strengths of the Preceptor and/or the clinical setting:
4. Please identify any weaknesses of the Preceptor and/or the clinical setting: