Saint Louis University
Doisy College of Health Sciences
Department of Occupational Science and Occupational Therapy
Student Evaluation of Level II Fieldwork Experience at Mid-Term
This evaluation is to be completed by the student at the mid-point of the
affiliation. The evaluation is both a method of review for the Student and Fieldwork
Educator, as well as a planning tool for the remaining second half of the experience.
It is intended to be mutually discussed and compared to the Fieldwork Educator
Evaluation of the Student’s Experience at Mid-Term. A copy of the fieldwork
Educator’s and the original of the Student’s mid-term evaluations are to be returned
to the Program in the provided mid-term envelope. Please maintain copies of the
evaluations for your records.
Rationale:
1. To assist the Student in identifying personal strengths and needs for continued
growth in this practice setting.
2. To facilitate discussion between the Student and the Fieldwork Educator
concerning the student’s status at the time of mid-term.
3. To promote a problem-solving atmosphere where the Student and Fieldwork
Educator can collaborate and plan further growth experiences.
Fieldwork Education Center _______________________________________________
Fieldwork Educator ______________________________________________________
Telephone number _______________________________________________________
Date _____________________________
Comments
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
1
Comments
I.
Orientation
Were you fully oriented to the department? . . . . . to the facility?
Do you feel the need for further or additional orientation? If so please indicate
which areas:
Do you feel the expectations were clearly defined during the orientation period?
Do you understand what you are expected to complete in terms of assignments?
II.
Performance
Are you able to keep up-to-date with written work?
How many hours per week do you average on assignments outside of the center?
Do you feel that you are carrying a client load compatible with your ability?
Are you able to find resource and reference materials for your client needs and
special interests?
Do you have special interest area(s) that you would like to pursue during the
remainder of your affiliation?
2
III.
Supervision
Comment on supervision in the following areas:
Regularly scheduled meeting times with your supervisor
Feedback from your supervisor regarding times use, paperwork, client rapport,
treatment/service planning, communication with other professionals, etc.
If you are supervised by more than one person, consistency of supervision
IV.
Communication
Comment on effectiveness of communication between yourself and your
supervisor, and list suggestions to improve communication, if needed.
Do you feel comfortable seeking assistance from professional staff, personnel from
other disciplines, aides, orderlies, secretaries, volunteers, etc.? Clarify any prolem
areas:
Are you comfortable with oral reporting . . .
With Supervisor(s)
In OT staff meetings
In team meetings
In family conferences
Other, specify.
3
V.
Professional/Personal Development
What do you see as your strengths?
What skills do you need to improve to become a competent entry-Level therapist?
____________________________________
______________________________ __________
Student Signature
Supervisor Signature
Date
(updated 05/07)
4