University of South Alabama
Department of Radiologic Sciences
Bi-Semester Clinical Evaluation of Professional Development and Growth Student
Student Name: ____________________________________
#in IHf
format
Student to maintain record,
clinical instructor to verify
Clinical Site: _______________________________________
Dates
Make up Date
Tardy
Absent
Early departure
Evaluator should circle or check the box that most accurately describes the student's performance during this
assignment, giving consideration to the length of time student has been part of the educational process.
Clinical Performance
Equipment &
Accessory
Manipulation
Excellent equipment &
accessory manipulation
skill; Operates without
difficulty.
Minimal difficulty
manipulating equipment
& accessories.
Lacks skill to
consistently operate
equipment &
accessories without
assistance.
Skills need
improvement;
Frequently needs
assistance and/or
reminders.
Technical Skill and
Knowledge
Demonstrates excellent
technical skill and
knowledge; The level of
help needed is
appropriate for this point
·in the educational
process.
Good technical skill and
knowledge; The level of
help needed is only
occasionally beyond
that which is appropriate
for this point in the
educational process.
Demonstrates some
difficulty; Needs more
help than should be
necessary considering
the point in the
educational process.
Lacks basic skills and/or
knowledge typical for
this point in the
educational process.
Needs much assistance
and guidance.
Patient Care and
Compassion
Excellent; Consistently
demonstrates
commitment to patient
dignity, esteem,
understanding, and
compassion; smiling,
helpful, respectful, and
courteous; Focused on
the patient.
Good; Typically
demonstrates
commitment to patient
dignity, esteem,
understanding, and
compassion; Treats the
patient with respect.
Occasionally fails to
attend to the concerns
of the patient; Needs to
be more attentive to the
patient.
Not consistent in
providing
compassionate care.
Improvement is needed.
Interest In Learning
Student frequently asks
questions and
demonstrates an
interest in learning;
Applies what has been
learned in the
classroom to the clinical
setting.
Demonstrates an
acceptable level of
interest in learning;
Occasionally asks
questions and/or
applies what has been
learned in the
classroom to the clinical
setting.
Only occasionally asks
questions or
demonstrates interest in
learning; Does not
easily apply what has
been learned in the
classroom to the clinic.
Does not demonstrate
an interest in learning in
the clinical setting;
Rarely asks questions
or shows interest;
Appears satisfied with
unsatisfactory effort.
Work Habits and
Efficiency
Effective at anticipating
and prioritizing tasks so
that work is
accomplished in an
efficient manner.
Anticipates needs.
Learns routine of the
area of assignment and
prioritizes tasks to fit
into that routine.
Occasionally anticipates
needs.
Occasionally
disorganized and in
need of assistance to
prioritize tasks so that
work is accomplished in
an efficient manner.
Regularly needs
guidance. Poor work
habits. Disorganized
and inefficient.
Communication
Skills
Excellent
communication skills.
Messages are
consistently clear and
professional.
Good communication
skills. Communicates
clearly.
Fair verbal and nonverbal communication
skills. Does not
consistently
communicate clearly.
Poor verbal and nonverbal communication
skills.
Student Name: ____________________________________
Attention to Detail
and Accuracy
Can be depended upon
to verify details before
proceeding. Excellent
attention to detail and
accuracy.
Level of attention to
details and accuracy is
good. Errors are
uncommon.
Occasional errors due to
lack of attention.
Although accuracy is a
goal, performance is not
consistent.
Careless and/or
inattentive to details;
Inattention leads to poor
outcomes.
Record Keeping
Excellent; Consistently
attentive to accurate,
timely, and detailed
record keeping.
Good; Record
keeping/chart notations
are usually neat,
accurate, timely and
adequately detailed.
Fair; Needs to improve
record keeping skills.
Poor record keeping
skills; Avoids
responsibility and/or
fails to provide neat,
accurate, and detailed
records.
Speed
Considering point in
educational process,
able to work at a fast
pace without negative
impact on accuracy.
Considering point in
educational process, is
able to work at a fairly
fast pace with only
minimal impact on
accuracy.
Improvement in speed
is needed. Need to find
ways to work more
efficiently so speed
does not negatively
impact accuracy.
Works too slowly to
maintain required
productivity or too fast to
achieve desired
accuracy. Improvement
is needed.
Consistency
Tends to demonstrate a
continuous acquisition of
knowledge; Retains
knowledge so that skills
demonstrated today are
consistently replicated
later.
Fairly consistent; Only
occasional reminders
are needed regarding
desired steps or
processes.
Occasionally requires
reminders of information
already covered.
Performance not
consistent.
Must be reminded
regularly of information
already covered. Does
not appear to retain
knowledge: Improvement
is needed.
Problem Solving
and Critical
Thinking Skills
Excellent; Consistently
evaluates all aspects of
an issue before making
a decision; Considers
the consequences of
taking a course of
action; Makes wise
decisions.
Good problem solving
and critical thinking
skills; Only occasionally
fails to evaluate an
aspect of an issue
before making a
decision.
Fair; Occasionally
makes a decision
without thinking through
the consequences; Does
not always consider all
of the elements and/or
consequences.
Relies on others to help
·make a decision; Unable
or unwilling to assess
the issues, consider the
consequences, and act
to make a decision.
Safe Health
Practices
Identifies potential
hazards; Consistently
monitors patient during
tx, washes hands
frequently; Practices
universal precautions;
Attentive to safety and
safe operation of
equipment.
Maintains a safe
environment; Failures to
watch patient during tx,
wash hands, practice
universal precautions, or
operate equipment in a
safe manner are
unusual.
Occasional failures to
watch patient during tx,
wash hands, practice
universal precautions, .
or operate equipment in
a safe manner.
Occasionally careless.
Corrective action is
needed.
Use of Time
Excellent; Uses time
wisely; Seeks out
opportunities to gain
clinical experiences;
Focused on clinical
education when in
clinic.
Good; Typically uses
time wisely; Typically
focused on clinical
education when in
clinic.
Occasionally misses
opportunities to gain
clinical experiences;
Needs to use spare
time to expand clinical
skills.
Professional·
Growth
The student is making
excellent progress; On
track for this point of the
educational process.
·Encourage student to
continue on present
course.
The student is making
good progress; On track
for this point of the
education.al proce.ss.
Only minimal areas
where student needs
improvement (as noted).
The student may be
behind in some areas
for this point of the
educational process.
With continued attention
and effort, however,
student should be able
to gain skills and
knowledge currently
lacking.
When spare time exists,
student must be
.prompted to stay busy
or attend a clinical
.activity in anoth.er area.
Needs to take
responsibility for wise
use of time.
The student is behind
what is expected for this
point of the educational
process. Student
needs to focus attention
on corrective measures.
Student Name: ____________________________________
Personal and Professional Behaviors
Attendance (score
based on poorest
performance in ill:!Y.
category i.e. 0
absences but 5
tardies = Poor)
Excellent
0 tardies
0 absences
0 early departures
Always reports in/out
Good
1 tardies
1 incidence absence
1 early departures .
Rarely fails to report
in/out
Fair
2- 3 tardies
2 incidence absence
2 - 3 early departures
Not consistent about
r porting in/out
Regularly fails to report
in/out
Appearance
Excellent appearance.
Professional at all
times.
Attentive to appearance;
Neat and clean.
Needs improvement;
Occasionally
demonstrates neglect or
lack of attention.
Personal appearance is
poor; Regularly
demonstrates neglect or
lack of attention.
Initiative
Self-starter; Stays busy,
looks for things to do;
Aggressively seeks out
learning opportunities;
Needs no reminders.
Typically stays busy;
Level of initiative is
good; Need for
prompting or reminder
is unusual.
Occasionally needs
prompting or reminders
about things that need
to be done or ways to
contribute.
Demonstrates little or no
initiative; Satisfied with
unsatisfactory effort.
Accountability and ·
Responsibility
Consistently holds self
accountable;
Takes responsibility for
actions and responds to
take corrective actions
that may be needed.
Takes responsibility for
actions; Only
occasionally
demonstrates hesitancy
in accountability or
taking responsibility.
Occasionally fails to
accept responsibility; Is
occasionally tempted to
point finger in another
direction.
Avoids responsibilities;
Satisfied with
unsatisfactory effort.
Attitude Toward
Coaching and
Feedback
Seeks constructive
criticism, coaching and
feedback, then changes
behavior as a result of
what is learned. Uses
feedback for its intended
purpose.
Accepts constructive
criticism, coaching and
feedback and usually
responds and adapts.
Student accepts
constructive criticism,
coaching and feedback,
but demonstrates little
change in behavior as a
result of the feedback.
Ignores or is defensive
or hostile when
confronted with
constructive criticism,
coaching, or feedback.
Needs to better accept
feedback as an
opportunity to learn.
Teamwork and
Cooperation
Has a positive influence
on the work
environment;
Consistently
cooperative; Looks for
ways to contribute;
Focused on positive
outcomes.
Cooperative and
supportive of team
efforts; Typically works
with others to
accomplish goals.
Occasionally lacks
interest in team efforts;
Contented to do own
thing. Needs to be more
attentive to needs of the
team.
Unless prompted,
contributes little to the
team's effort.
Poor
> 3 tardies
> 2 incidence absence
> 3 early departures
Student Name: ____________________________________
Please identify strengths and opportunities for improvement noted during this assignment: (use
reverse side of form if additional space is needed)
Comments:(optional)
_
To be completed by Faculty Member
Poss
Points
Min
Points
Earned
Points
Clinical Performance (14 X 5)
70
48
_______
Per and Prof
Behaviors (6 X5)
30
20
_______
*Student must earn the minimum required points on both Section 1
and Section 2 AND a minimum total score of 70% to earn a passing
score.
Score ___________________
Signature of Evaluator*
Date:
Signature of Student
Date:
Signature of Faculty Member
_
Initials _______________________
Date:
(Your signature on this form does not imply agreement with the evaluation, but indicates that you have
read it, are aware of its content, and understand that this will become part of your permanent file.)