STUDENT COMPREHENSION OF PROCEDURE (CIRCLE ONE ONLY):

RATING EXPLANATION

5 Student demonstrates comprehensive knowledge of basic and advanced concepts beyond requirements of procedure. This is for the student that “blows you away” with critical thinking concepts and goes beyond the level of their current education.

4 Student shows above average understanding of basic concepts applicable to the skill

demonstrated. This is for the student who does a bit more than the basic proficiency, and can extrapolate ideas and concepts related to the check-off.

3 Student demonstrates adequate knowledge of the essential elements of the task performed. This is for the student who does the minimum and does not offer any rationale or explanation beyond what is required.

2 Student shows limited understanding of essential concepts related to the procedure. This is for the student who struggles with check-off and need much coaching and prompting to perform procedure correctly

1 Student has inadequate knowledge of even the basic concepts related to the task at hand and cannot perform the task correctly with multiple attempts.

ADDITIONAL COMMENTS: please include errors of omission or commission; communication skills (verbal and nonverbal) and effectiveness of patient interaction:

SUMMARY PERFORMANCE EVALUATION AND RECOMMENDATIONS:

SETTING:

CLINICAL: __________ SATISFACTORY; ready for minimally supervised application and

refinement

_________ UNSATISFACTORY; requires additional supervised clinical practice:

_______ complete re-evaluation required

_______ re-evaluation: minor deficiencies only

DATE: _________________ EVALUATOR SIGNATURE: ________________________________

STUDENT SIGNATURE: _________________________________