FOR FACULTY USE ONLY RSPT COMPLETION OF CLINICAL OBJECTIVES SUPERVISOR ROTATION. Student Name TIME
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1 COMPLETION OF CLINICAL OBJECTIVES SUPERVISOR ROTATION Student Name TIME Date Time In Signature In Time Out Signature Out Hours I certify that the hours listed on this sheet are correct. Student Date FOR FACULTY USE ONLY YES NO NUMBER HOURS COMPLETE c c DAYS ABSENT OBJECTIVES COMPLETE c c DAYS TARDY DAILY EVALUATIONS c c NEEDS IMPROVEMENT INSTRUCTOR EVALUATION c c DID NOT MEET OBJECTIVE ROTATION EVALUATION c c 75% PASSING EVALUATIONS c c All requirements complete: Instructor Date ADDITIONAL COMMENTS:
2 SUPERVISORY ROTATION CLINICAL OBJECTIVES STUDENT OBJECTIVES DATE AND SIGNATURE 1. Observe and/or assist in completing the procedure count for the oncoming shift and in making daily work assignments. 2. Perform patient care as assigned. 3. Observe and/or assist in equipment maintenance and/or cleaning. 4. Observe and/or assist in maintaining the department s cleanliness, neatness, and safety. 5. Perform other duties and procedures as assigned by the Lead Therapist.
3 STUDENT EVALUATION SUPERVISORY ROTATION Student Hospital Complete this evaluation during or at the end of the shift by rating the student using the following guidelines: S = satisfactory N = need improvement D = does not meet objective NA = not observed The student: Date 1. Arrived to clinic on time. 2. Met dress code requirements (uniform, shoes, name badge, stethoscope, glasses). 3. Demonstrated a professional behavior toward patients and staff. 4. Communicated well with patients, RC staff, nurses and physicians. 5. Organized work load and used time effectively. 6. Performed assigned procedures on time. 7. Accepted criticism and utilized suggestions. 8. Effectively applied problem-solving strategies to patient care. 9. Recognized equipment malfunctions and tried to provide corrective action(s). 10. Performed at a safe and conscientious level of practice. 11. Completed scheduled shift (8 hours, 12 hours). Evaluator Signature Student Signature Evaluators and students: Use the back of this page to make comments. Include date and signature.
4 INSTRUCTOR EVALUATION Instructor Hospital Rotation Dates of Rotation Agree Disagree 1. The instructor exhibits a good attitude regarding working with students. 2. The instructor exhibits professionalism when working with patients, staff and students. 3. The instructor assists students in structuring their time so that clinical objectives can be met. 4. The instructor assists students in the acquisition of equipment and reference materials. 5. The instructor allows for time to work directly with students and answer questions. 6. The instructor answers students questions on a level they understand. 7. The instructor is knowledgeable in the areas assigned. 8. The instructor is fair when completing student evaluations. Evaluator: PLEASE WRITE COMMENTS ON BACK
5 INSTRUCTOR EVALUATION Instructor Hospital Rotation Dates of Rotation Agree Disagree 1. The instructor exhibits a good attitude regarding working with students. 2. The instructor exhibits professionalism when working with patients, staff and students. 3. The instructor assists students in structuring their time so that clinical objectives can be met. 4. The instructor assists students in the acquisition of equipment and reference materials. 5. The instructor allows for time to work directly with students and answer questions. 6. The instructor answers students questions on a level they understand. 7. The instructor is knowledgeable in the areas assigned. 8. The instructor is fair when completing student evaluations. Evaluator: PLEASE WRITE COMMENTS ON BACK
6 CLINICAL ROTATION EVALUATION Hospital Rotation Dates of Rotation Agree Disagree 1. This rotation met my expectations. 2. The time allotted to this rotation was about right. 3. I did not find it necessary to spend time outside assigned clinic to complete the objectives. 4. The objectives for this rotation were easy to understand. 5. The number of objectives for this rotation was about right. 6. The objectives for this rotation were appropriate to clinical practice. 7. This site is appropriate for this rotation. 8. The procedures, equipment and information required to complete this rotation were readily available at this site. 9. The instructors at this site showed an interest in me and were willing to assist me in completing my objectives. 10. The AC faculty assigned to this rotation were available at scheduled times to assist me in completing my objectives. 11. This rotation has prepared me to work as a staff therapist in this clinical area. Evaluator: PLEASE WRITE COMMENTS ON BACK
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