Clinical Instructor’s Evaluation of the Student 2005©
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Student’s name |
Rotation Number: |
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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.
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Affective Domain |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
N/A |
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1 |
Student identifies patient and interacts appropriately. |
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2 |
Student communicates effectively with the clinical staff. |
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3 |
Student cooperates with the clinical staff. |
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4 |
Student’s actions in patient care are appropriate. |
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5 |
Student is prompt and professional in actions and in appearance. |
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6 |
Student is attentive when patient examinations are in progress. |
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7 |
Student completes assigned tasks in a timely fashion. |
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8 |
Student exercises professional conduct in the clinical setting. |
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Psychomotor Domain |
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9 |
Student turns on
equipment and performs laboratory start up. |
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10 |
Student prepares the examination
room. |
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11 |
Student performs appropriately
in the clinical setting. |
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12 |
Student aligns the plane
of view on longitudinal and transverse structures. |
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13 |
Student uses transducer
appropriately to display anatomy. |
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14 |
Student cleans transducer
after use. |
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15 |
Student turns off
equipment and performs laboratory shut down. |
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Cognitive Domain |
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16 |
Student Identifies the
pertinent clinical questions and the goal of the examination. |
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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. |
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18 |
Student can relate
sonograms to other modalities and recognizes normal anatomy. |
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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. |
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