1
McGill University
School of Communication Sciences and Disorders
STUDENT EVALUATION FORM
Student:
Dates of Practicum:
Practicum Site:
City:
Province/State:
Name(s) of Clinical Educator(s):
Please refer to the instructions in the Clinical Training Manual before completing the Student Evaluation
Form.
NB*: Throughout the Form ‘Clinical Educator’ is abbreviated to CE.
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Competency I: Professional Skills & Professional Development
SUMMARY
Please enter an overall rating for Competency I on the 1-5 scale below; 0.5 scores may be used.
unacceptable
needs
improvement
average
above
average
excellent
midterm
1
2
3
4
5
final
1
2
3
4
5
Please check ONLY any areas that require improvement.
Checked = needs improvement but skill is developing
Add * to if lack of improvement constitutes a concern
MIDTERM
FINAL
**Double click on the checkboxes and select ‘checked’ to check off the desired boxes (if typing on form)
needs improvement
needs improvement
1. Adheres to professional standards, ethics, policies
2. Has positive attitude & openness to CE & to learning
3. Has good rapport & professional manner with CE
4. Has good rapport & professional manner w/clients; team
5. Respects confidentiality
6. Is appropriate, appearance, dress code, name tag
7. Is on time
8. Is prepared (familiarity w/tests; sessions; etc)
9. Meets deadlines (reports, therapy plans, etc.)
10. Shows effective time management (Internship)
11. Takes initiative
12. Demonstrates self-directed learning&independence
13. Seeks assistance & feedback when necessary
14. Incorporates CE’s suggestions
15. Is able to self- (peer-) evaluate
COMMENTS COMPETENCY I.
Mid-term: Clinical Educator
Strengths:
COMMENTS COMPETENCY I.
Mid-term: Student self-evaluation
Strengths:
Areas for improvement:
Areas for improvement:
Strengths:
Final: Clinical Educator
Final: Student self-evaluation
Strengths:
Areas for improvement:
Areas for improvement:
3
Competency II: Interpersonal Skills & Communication Skills
SUMMARY
Please enter an overall rating for Competency II on the 1-5 scale below; 0.5 scores may be used.
unacceptable
needs
improvement
average
above
average
excellent
midterm
1
2
3
4
5
final
1
2
3
4
5
Please check ONLY any areas that require improvement.
Checked = needs improvement but skill is developing
Add * to
if lack of improvement constitutes a concern
MIDTERM
needs improvement
FINAL
needs improvement
1.
2.
3.
4.
5.
6.
7.
8.
9.
Fosters trust & respect w/CE, clients; etc.
Is perceptive to client/caregiver needs
Is able to address client/caregiver needs
Perceives/interprets nonverbal cues/body language
Adapts to change/is flexible
Is a good communicator
Speaks clearly and at an appropriate rate & pitch
Modifies language to suit client’s needs
Adapts technical language to knowledge level of
clients/team during oral communication
10. Ditto for written communication
11. Ability to facilitate communication verbally/nonverbally
COMMENTS COMPETENCY II.
Mid-term: Clinical Educator
Strengths:
COMMENTS COMPETENCY II.
Mid-term: Student self-evaluation
Strengths:
Areas for improvement:
Areas for improvement:
Strengths:
Final: Clinical Educator
Final: Student self-evaluation
Strengths:
Areas for improvement:
Areas for improvement:
4
Competency III: Practice Knowledge & Clinical Reasoning Skills
SUMMARY
Please enter an overall rating for Competency III on the 1-5 scale below; 0.5 scores may be used.
unacceptable
needs
improvement
average
above
average
midterm
1
2
3
4
5
final
1
2
3
4
5
Please check ONLY any areas that require improvement.
Checked = needs improvement but skill is developing
Add * to
excellent
if lack of improvement constitutes a concern
MIDTERM
needs improvement
FINAL
needs improvement
1. demonstrates theoretical knowledge
2. applies academic information
3. researches problems (readings, previous exp.)
4. demonstrates analytical thinking
5. demonstrates judgement and decision making
6. able to solve problems
7. demonstrates reasoning based on evidence
COMMENTS COMPETENCY III.
Mid-term: Clinical Educator
Strengths:
COMMENTS COMPETENCY III.
Mid-term: Student self-evaluation
Strengths:
Areas for improvement:
Areas for improvement:
Strengths:
Final: Clinical Educator
Final: Student self-evaluation
Strengths:
Areas for improvement:
Areas for improvement:
5
Competency IV: Clinical Performance
Please list the learning objectives from the Practicum Contract on the lines below.
You may have less than 7 objectives (or more than 7), as desired.
Any written comments should be made on pages 6 - 8.
N/A unacceptable below
average
1. ____________________
average
above
average
excellent
midterm
1
2
3
4
5
final
1
2
3
4
5
midterm
1
2
3
4
5
final
1
2
3
4
5
midterm
1
2
3
4
5
final
1
2
3
4
5
midterm
1
2
3
4
5
final
1
2
3
4
5
midterm
1
2
3
4
5
final
1
2
3
4
5
midterm
1
2
3
4
5
final
1
2
3
4
5
midterm
1
2
3
4
5
final
1
2
3
4
5
2. ___________________
3. ___________________
4. ___________________
5. ___________________
6. ____________________
7. ___________________
Competency IV Clinical Performance: SUMMARY
unacceptable
midterm
1
below
average
2
final
1
2
average
excellent
3
above
average
4
3
4
5
5
6
To be completed by the Clinical Educator
Clinical educator, please also comment on any of the following, if you wish:
-
were general/specific expectations met
for Competency IV (re. column 2 Contract): level of independence demonstrated
for Competency IV: (re. column 3 Contract): evidence that the criteria for specific learning objectives were met
any (subjective) comments about where the student is estimated to be on the “clinical education continuum”
other
COMPETENCY IV - COMMENTS
Mid-term
Strengths:
Areas for Improvement:
Final
Strengths:
Areas for Improvement:
7
Student Self-Evaluation
COMPETENCY IV - COMMENTS
Mid-term
Strengths:
Areas for Improvement:
Final
Strengths:
Areas for Improvement:
8
In the event that the student is supervised by more than one CE onsite, please ensure that all
CE’s have provided input. They must also co-sign the form.
MID-TERM
_____________________________
Clinical Educator(s)
________________________
Student
_____________
Date
_____________________________
2nd Clinical Educator (if applicable)
FINAL EVALUATION
Please check one of the following (only at the final evaluation):
I recommend that the student receive a Pass for this practicum.
I recommend that the student receive a Pass with Reservations for this practicum.
Comments:
I cannot recommend that the student receive a Pass for this practicum.*
_____________________________
Clinical Educator
________________________
Student
_____________
Date
_____________________________
2nd Clinical Educator (if applicable)
Signatures used on this form must be unique, original signatures1.
RISK OF FAILURE
* Please notify the clinical coordinator at McGill prior to assigning a FAIL.
In addition, the Performance Problem Protocol should have been affected before a FAIL is
assigned (refer to Clinical Training Manual).
The Student is required to submit this form in electronic format to:
1) practicum.scsd@mcgill.ca
AND
2) CE’s email (at the same time)
Before 11:59pm on Sunday following completion from his/her McGill email address (name@mail.mcgill.ca).
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A unique, original signature is either a pen signature or a unique digital signature. Do not simply type your names on this form when submitting electronically.
StudentEvalEN