UAB Nurse Anesthesia Program
School of Health Related Professions
The University of Alabama at Birmingham
- Resident Nurse Anesthetist Evaluation of Clinical Faculty Name of Clinical Faculty:
Affiliate:
Date: Jun-Nov or Dec-May
(circle one)
Below Expectations
Meets Expectations
1
Area of Assessment
1
2
Exceeds Expectations
3
Clinical Faculty’s Comments
3
Provides consistent, objective
assessment of SRNAs.
Remains current with
advancements in the field of
anesthesia.
Encourages SRNA autonomy
when appropriate circumstances
permit.
(e.g., pushing own drugs
Completes daily evaluations and
provides verbal feedback for
SRNAs
Promotes a positive atmosphere
in the clinical area that enhances
learning.
Serves as professional role
model in dealing with surgeons,
anesthesiologists, SRNAs, and
patients.
OVERALL EVALUATION
Check here
2
Strengths of Clinical Faculty:
Areas Needing Improvement for Clinical Faculty:
Areas Needing Improvement
Areas Needing Improvement
if more comments are listed on the backside of this form. Be sure to complete this evaluation at the end of each clinical rotation
on every clinical faculty you worked with (including the Nurse Anesthesia Program faculty) and submit the completed evaluation as part of the
required checklist for monthly I rotational forms. For resident nurse anesthetists who remain at a site for an extended period of time (e.g.,
Tuscaloosa -DCH), this form should be completed every time a summative evaluation is done. There should be one form completed for every
clinical faculty you worked with -only one form per faculty regardless of the number of times you worked with that individual. Ms. Spencer will
type your comments into a "general evaluation" form to
05/23/01