FORMS FOR USE IN CLINICAL EDUCATION
This section of the syllabus is a resource for center coordinators and clinical instructors
in the event that some additional structure is needed or desired for work with any
student. We do not require that you use any of these forms with our students –
they are strictly for your convenience! In the unlikely event that you need to work with
one of our students with specific performance concerns, it is our intention to be involved
in that process to whatever degree you feel is necessary. We can consult with you by
phone, provide guidance and feedback to the student, make site visits to assist in
planning for additional work in areas of concern, or whatever else you deem needed.
Just give us a call. We are happy to help.
Weekly forms
These forms provide a structure for weekly feedback and planning. They may be useful
for students who need additional guidance in planning for their weekly activities, for
students who are reticent to provide you with feedback about your clinical instruction, or
for environments where “sit down” meeting time is hard to arrange. The student can fill
out a form each week to summarize learning experiences and plan for the next step.
These forms are appropriate for all levels of students, and are most useful when the
instructor and student can review it together for discussion about communication issues
and upcoming goals. There are 2 different weekly forms included the Weekly Planning
Form (short) and the Weekly Review Form (more detailed).
Generic abilities assessment
This assessment is used at UNC-CH in the Clinical Education course for all students to
reflect on issues related to professional behavior. The 10 “generic” abilities are qualities
that apply to many professional situations – and are skills that therapists continue to
work toward after they become licensed therapists. The grid that lists criteria for each
generic ability can be used as a means for a student to self-assess by highlighting
behaviors he or she consistently demonstrates in a few categories or in the entire
assessment. The behaviors are divided into beginning level, developing level and entry
level representing a continuum of performance. Example behaviors represent the
original criteria identified by Warren May, as well as criteria that have been written by
UNC faculty and represent classroom activities with which students may be more
familiar. Students are already familiar with this form and have used it previously for self
assessment. Clinical instructors may also use these behavioral criteria to describe
goals for students who are struggling in areas of professional behavior.
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Anecdotal record
This form is used in instances where a record of performance is necessary to formalize
feedback with a student. The form is useful as an adjunct to other evaluation tools used
for determination of grades – as a way to support your observations, in the event that
specific instances need to be recalled. The situation is described in the setting, the
student action or behavior that was observed is also detailed. The behavior should be
described in objective terms without judgmental adjectives. The evaluator interpretation
allows the CI to list possible consequences of the behavior revealing reasons for
concern. The student and CI both sign the form to indicate that this feedback was
shared. The student may then make comments if necessary in the final section of the
form.
Critical incident report form
This form may also prove useful in situations where problematic behaviors in a similar
category are observed with a student (i.e. safety issues). This is also useful as an
adjunct to the typical evaluation done for the school. This form is designed to only
include a description of the behaviors without any interpretation on the part of the
instructor. Antecedents refer to events or environmental factors that preceded the
behavior. Behaviors are described objectively. Consequences include any
ramifications for the behavior imposed by the CI. For instance, if a safety problem has
been identified and discussed with the student, the critical incident report form could be
used. After the first additional safety issue occurs, the consequence could be a verbal
warning and discussion of reasons for concern, but yet another instance of unsafe
behavior could result in a call to the ACCE or documentation in the written evaluation.
Learning Contract Form
This form provides a structure for development of specific objectives and learning
activities for exceptional students. In the event that you need to use this forms, the
student can be actively involved in the process of developing objectives and
determining appropriate activities to meet those goals.
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