Student Clinical Performance Summary

The evaluator should select the letter to the corresponding phrase which best describes the student’s work pattern in that work area. A rating of an “A” or “C” will require supportive comments on area provided following the question.

Evaluation Code:
A……..to………C
Excellent………Poor
Always………...Seldom
Very Much…….Very Little

 Please only hit the Submit button one time.  If you have any difficulties, please contact Dana Clay.

Evaluator:
Student Name:
  Date: 
  Date(s) Covered: 
  Work Area: 
  Hospital: 
Shift: 

 


I.  Task Competency
 
   
1. Quality of Work: Maintains high quality standards

For an answer of A or C, please post comments supporting your choice:

   
2. Clinical Assignments:  Completes work assigned

For an answer of A or C, please post comments supporting your choice:

   
3. Use of Equipment & Supplies:  Exercises care in use

For an answer of A or C, please post comments supporting your choice:

   
4. Dexterity:  Demonstrates proficiency in assembling or setting up equipment

For an answer of A or C, please post comments supporting your choice:

   


II.  Job Knowledge, Problem Solving
 
   
5. Learning:  Grasps instructions readily


 
For an answer of A or C, please post comments supporting your choice:

   
6. Judgment:  Makes decision considering acceptable alternatives

For an answer of A or C, please post comments supporting your choice:

   
7. Adaptation of Experience:  Adapts classroom knowledge to clinical situation

For an answer of A or C, please post comments supporting your choice:

   
8. Communication:  Communicates knowledge to staff

For an answer of A or C, please post comments supporting your choice:

   
9. Communication:  Communicates knowledge to patient

For an answer of A or C, please post comments supporting your choice:

   


III.  Personal Behavior
 
   
10. Interest:  Motivation

For an answer of A or C, please post comments supporting your choice:

   
11. Tact & Courtesy:  Tactful and considerate of others

For an answer of A or C, please post comments supporting your choice:

   
12. Personal Grooming:  Appropriately dressed for clinical setting

For an answer of A or C, please post comments supporting your choice:

   
13. Initiative and Responsibility: Supervision not required

For an answer of A or C, please post comments supporting your choice:

   
14. Self-Confidence:  Displays confidence to staff

For an answer of A or C, please post comments supporting your choice:

   
15. Self-Confidence:  Displays confidence to patients

For an answer of A or C, please post comments supporting your choice:

   


IV.  Overall Performance
 
   
16. The student’s general performance during this rotation

For an answer of A or C, please post comments supporting your choice:

   

Attendance
Absent/ Tardy Date Time Called Comment/Arrival Time Reason
Instructor’s Comments on Overall Performance: 
Include strong points, weak points, and suggestions for improvement in clinical performance.