Department of Radiologic Sciences
University of South Alabama
Tri-Semester Clinical Evaluation
Student ________________________________ Semester _________________
Date ___________________________________ Total Number of Examinations _______
Clinical Site: ____________________________
I.
Technical Skills
A. Equipment Manipulation
_____ Number of Major Errors ____________________________________
_____ Number of Other Errors ____________________________________
________________________________________________________________________
B. Radiographic Positioning
_____ Number of Major Errors ____________________________________
_____ Number of Other Errors ____________________________________
________________________________________________________________________
C. Radiographic Technique
_____ Number of Major Errors ____________________________________
_____ Number of Other Errors ____________________________________
________________________________________________________________________
D. Radiographic Procedure and Integration and Transfer of Theory
_____ Number of Major Errors ____________________________________
_____ Number of Other Errors ____________________________________
________________________________________________________________________
E. Patient Care
_____ Number of Major Errors ____________________________________
_____ Number of Other Errors ____________________________________
________________________________________________________________________
_____Point(s) Reduction for Section I
______________________________________________________________________________
II.
Radiation Protection
_____ Number of Errors
Zero errors observed = 0 points
One error in this category = -3 points
Two or more errors in this category = -6 points
_____Point(s) Reduction for Section II
Student Name: _______________________________
Clinical Site: _________________________________
III. Professional/Clinical Expectations
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.
Patient Care and
Compassion
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
Demonstrates an acceptable
level of 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
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
Good communication skills.
Communicates clearly.
Fair verbal and non-verbal
communication skills. Does
not consistently
communicate clearly.
Poor verbal and non-verbal
communication skills.
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.
Speed
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; 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
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
Maintains a safe
environment; Monitors
patient during examination,
washes hands frequently;
Practices universal
precautions; Attentive to
radiation safety and safe
operation of equipment
Occasional failures to watch
patient during examination,
wash hands, practice
universal precautions, or
operate equipment in a safe
manner.
Occasionally careless.
Corrective action is needed.
Student Name: _______________________________
Clinical Site: ________________________________
Use of Time/
Initiative
Seeks out opportunities to
gain clinical experiences;
Typically uses time wisely;
Typically focused on
clinical education when in
clinic; Level of initiative is
good; Need for prompting
or reminder is unusual.
Occasionally misses
opportunities to gain clinical
experiences; Needs to use
spare time to expand clinical
skills; Occasionally needs
prompting or reminders
about things that need to be
done or ways to contribute.
When spare time exists,
student must be prompted to
stay busy or attend a clinical
activity in another area. Needs
to take responsibility for wise
use of time; Demonstrates
little or no initiative; Satisfied
with unsatisfactory effort.
Professional
Growth
The student is making good
progress; On track for this
point of the educational
process. Only minimal
areas where student needs
improvement.
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.
The student is behind what is
expected for this point of the
educational process. Student
needs to focus attention on
corrective measures.
Appearance/
Attentive to appearance;
Neat and clean. Properly
prepared for clinical
rotation.
Needs improvement;
Occasionally demonstrates
neglect or lack of attention.
Occasionally not prepared
for clinical rotation.
Accountability
and
Responsibility
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
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
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.
Total Number of Items
Marked _____ X -1 = _____
Unless prompted, contributes
little to the team’s effort.
Preparedness
Total Number of Items
Marked _____ X 0 = _____
Personal appearance is poor;
Regularly demonstrates
neglect or lack of attention.
Regularly unprepared for
clinical rotation.
Total Number of Items
Marked _____ X -2 = _____
_____Point(s) Reduction for Section III
______________________________________________________________________________
Strengths/Opportunities for Improvement
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
______________________________________________________________________________
Student Name: _______________________________
Clinical Site: _________________________________
IV. Professional Responsibilities
A. Attendance
Refer to Student Reference Manual regarding attendance policy
________________________________________________________________________
B. Promptness/Early Departure
Every lateness or early departure after the first two incidences will result in a
3-point reduction per occurrence.
________________________________________________________________________
C. Properly Notifies Clinical Instructor
(Applies to absences, early departures and tardiness)
Yes = -0 points
No = -5 points
________________________________________________________________________
D. Weekly Clinical Observation Form
Forms turned in as stated in Student Reference Manual
Notations are neat and accurate
Sufficient number or variety of examinations recorded
Yes = -0 points
No = -5 points
________________________________________________________________________
E. Direct/Indirect Supervision
Failure to follow guidelines regarding repeat radiographs and/or policy of direct
and indirect supervision as defined in the Student Reference Manual.
-5 point per occurrence
________________________________________________________________________
F. Professional Demeanor Violation date _______ make-up date ________
Dress Code Violation
date _______ make-up date ________
________________________________________________________________________
_____Point(s) Reduction for Section IV
______________________________________________________________________________
Additional Comments
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
_______________________________________________
Clinical Instructor’s Signature
_____________________
Total Points
_______________________________________________
Student’s Signature
_____________________
Date
Your signature on this form does not mean that you agree with the
clinical evaluation. It does, however, indicate that you have read the
evaluation, understand items checked and their significance, and that this
will become part of your permanent file.
Grade Scale
90 – 100 = A
80 – 89 = B
70 – 79 = C
60 – 69 = D
0 – 59 = F