Name:
Clinical Experience Summary
Yr. -20 Semester: Fall/Spring
Provide a brief description of your duties/responsibilities at your clinical site assignment:
Using a 5-point scale, please indicate your perception of having received an adequate clinical experience in the following areas:
1)
1 = Strongly Disagree (SD)
2 = Disagree (D)
3 = Undecided (U)
Risk Management and Injury Prevention
2) Pathology of Injuries and Illnesses
3) Assessment
4 = Agree (A)
5 = Strongly Agree (SA)
SD
1
1
D
2
2
4) Acute Care of Injury and Illness 1 2
U
3
3
3
A
4
4
4
SA
5
5
5
8)
9)
General Medical Conditions and Disabilities
Nutritional Aspects of Injury and Illness
10) Referral
1
1
2
2
3
3
4
4
5
5
12) Professional Development and Responsibilities
14) Time commitment was about what
1 2 3 4 5
15) Was time provided for in-service discussions on relevant AT topics?
16) Overall rating for your Clinical Supervisor
(1 = poor and 5 = excellent)
1
1
2
2
3
3
4
4
5
5

Overall, what part of your clinical experience was most rewarding?
What suggestions do you have for improving, revising, or refining the clinical experience at this site?
The following questions relate to your interaction with your Approved Clinical Instructor (ACI):
(use additional sheets if necessary)
1) What did you like best about your ACI?
2) What specific skills have you developed or enhanced as a result of working with your ACI?
3) What did you least enjoy about your ACI?
4) What could be done to improve the quality of instruction from this ACI?
5) Comment on the quality of interaction and feedback you received from your ACI?
Additional comments: (use additional pages if necessary)