Clinical Instructor’s Evaluation of the Student 2005©
|
Student’s name |
Rotation Number: |
|
Clinical Site |
Clinical Instructor(s) |
The student will not be expected to
perform a complete sonographic examination until they have received appropriate
instruction for that examination. N/A is Not Applicable or Not Observed and is
not used in grade calculations.
Evaluate each area of performance (Poor = 1, Good = 5, Excellent = 10). For
scores of less than 7, the instructor should identify the item by number and
give a brief explanation to help the student improve on that item. ©2005 All rights reserved.
|
|
Affective Domain |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
N/A |
|
1 |
Student identifies patient and interacts appropriately. |
|
|
|
|
|
|
|
|
|
|
|
|
2 |
Student communicates effectively with the clinical staff. |
|
|
|
|
|
|
|
|
|
|
|
|
3 |
Student cooperates with the clinical staff. |
|
|
|
|
|
|
|
|
|
|
|
|
4 |
Student’s actions in patient care are appropriate. |
|
|
|
|
|
|
|
|
|
|
|
|
5 |
Student is prompt and professional in actions and in appearance. |
|
|
|
|
|
|
|
|
|
|
|
|
6 |
Student is attentive when patient examinations are in progress. |
|
|
|
|
|
|
|
|
|
|
|
|
7 |
Student completes assigned tasks in a timely fashion. |
|
|
|
|
|
|
|
|
|
|
|
|
8 |
Student exercises professional conduct in the clinical setting. |
|
|
|
|
|
|
|
|
|
|
|
|
|
Psychomotor Domain |
|
|
|
|
|
|
|
|
|
|
|
|
9 |
Student turns on
equipment and performs laboratory start up. |
|
|
|
|
|
|
|
|
|
|
|
|
10 |
Student prepares the examination
room. |
|
|
|
|
|
|
|
|
|
|
|
|
11 |
Student performs appropriately
in the clinical setting. |
|
|
|
|
|
|
|
|
|
|
|
|
12 |
Student aligns the plane
of view on longitudinal and transverse structures. |
|
|
|
|
|
|
|
|
|
|
|
|
13 |
Student uses transducer
appropriately to display anatomy. |
|
|
|
|
|
|
|
|
|
|
|
|
14 |
Student cleans transducer
after use. |
|
|
|
|
|
|
|
|
|
|
|
|
15 |
Student turns off
equipment and performs laboratory shut down. |
|
|
|
|
|
|
|
|
|
|
|
|
|
Cognitive Domain |
|
|
|
|
|
|
|
|
|
|
|
|
16 |
Student Identifies the
pertinent clinical questions and the goal of the examination. |
|
|
|
|
|
|
|
|
|
|
|
|
17 |
Student recognizes
significant clinical information and historical facts from the patient and
the medical records, which may impact the diagnostic examination; and the
student keeps medical records according to the clinic’s protocol. |
|
|
|
|
|
|
|
|
|
|
|
|
18 |
Student can relate
sonograms to other modalities and recognizes normal anatomy. |
|
|
|
|
|
|
|
|
|
|
|
|
19 |
Student reviews data from
current and previous examinations to produce a written/oral summary of
technical findings, including relevant interval changes, for the interpreting
physician’s reference. |
|
|
|
|
|
|
|
|
|
|
|
|
20 |
Student selects the
correct transducer type and frequency for examination(s) being performed. |
|
|
|
|
|
|
|
|
|
|
|
|
21 |
Student adjusts
instrument controls including exam presets, scale size, focal zone(s),
overall gain, time gain compensation, and frame rate to optimize image
quality. |
|
|
|
|
|
|
|
|
|
|
|
|
22 |
Student demonstrates
knowledge and understanding of Doppler ultrasound principles, spectral
analysis, and color flow imaging relevant to specialty being assessed. |
|
|
|
|
|
|
|
|
|
|
|
|
23 |
Student demonstrates
knowledge and understanding of anatomy, physiology, pathology and
pathophysiology relevant to specialty being assessed. |
|
|
|
|
|
|
|
|
|
|
|
|
24 |
Student demonstrates the
ability to perform sonographic examinations and measurements of the
appropriate organs and areas of interest according to professional and
employing institution protocols. |
|
|
|
|
|
|
|
|
|
|
|
|
25 |
Student recognizes,
identifies and documents the abnormal sonographic patterns of disease
processes, pathology, and pathophysiology of the organs and areas of
interest; and modifies the scanning protocol based on the sonographic
findings and the differential diagnosis. |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total points for Affective |
|
|
|||||||||
|
|
Total points for Psychomotor |
|
|
|||||||||
|
|
Total points for Cognitive |
|
|
|||||||||
|
|
Total all points |
|
|
|||||||||
|
|
Percentage Grade = (accumulated points/250 possible points) x 100 |
|
|
|||||||||
Date: Signatures: Student:
Instructor:
Clinical
Instructor’s Evaluation of the Student 2005
|
To help the student improve on deficient skills the Clinical Instructor should identify any items having a score of less than 7 and make a brief comment about the nature of the deficiency. |
INSTRUCTOR COMMENTS:
Item #(s) Comments:
STUDENT COMMENTS:
Item #(s) Comments: