SECCION CARTELES PAGADOS
JUICIOS DE AUSENCIA
This is to acknowledge that I have seen and discussed its contents with the evaluator. Student’s Signature _____________________ Date ___________________ Preceptor’s Signature ___________________ Date ___________________
constructive evaluation of the student’s performance during his/her clinical experience. Review the information below and make an appointment with your clinical preceptor to discuss any questions regarding the content of this form. After reviewing and understanding all the information contained in this form, please sign and return to the Clinical Education Coordinator. This form will be retained in your permanent academic file within the Athletic Training Program. These forms will be completed at mid-rotation and at the end of each clinical rotation to assist in measuring student progress.
Student Name: Clinical Preceptor:
Sport Assignment: Date of Rotation:
Student Evaluation
Please assign the number that best applies to the statement regarding the athletic training student. Please leave any question that is not applicable to your situation blank.
KEY
1-Seldom 2-Occasionally 3-Fairly Often 4-Almost Always 5-Always
I. Administration/Professionalism
1.1. Demonstrates punctuality and dependability _______
1.2 Dresses appropriately _______
1.3 Demonstrates professionalism with athletes _______
1.4 Demonstrates professionalism with coaches and other athletic trainers _______
1.5 Adheres to athletic training room procedures _______
1.6 Maintains a balance between personal and professional relationships _______
1.7 Assists in preparation for games and practices _______
1.8 Cooperates with other athletic training students _______
1.9 Demonstrates emotional maturity and effective coping skills _______ 1.10 Demonstrates overall awareness during the games and practices _______ 1.11 Understands and demonstrates knowledge of event management _______ 1.12 Understands current limitations and seeks assistance when necessary _______
II. Methods for Improving Skills
2.1 Receives and responds to constructive criticism _______
2.2 Displays an eagerness to learn and asks questions _______
2.3 Mentors observation students _______
2.4 Takes an active role in learning _______
2.5 Accepts responsibility _______
2.6 Conveys respect for the clinical instructor’s opinion _______
2.7 Conveys respect for other athletic training students’ opinions _______
III. Communication Skills
3.1 Speaks clearly with tact and discretion _______
3.2 Communicates in an organized logical manner _______
3.3 Recognizes the effects of non-verbal communication _______
3.4 Exhibits confidence with skills and knowledge _______
3.5 Communicates daily with the supervising clinical instructor _______
immediate vicinity is not necessary.
2-Student requires supervision from the clinical instructor. Student needs verbal cueing or physical
assistance from the clinical instructor.
1-Student requires constant supervision from the clinical instructor and cannot accomplish the task
without the instructor.
N/A-Not applicable N/O-Not observed
IV. Administration Skills
4.1 Demonstrates and maintains accurate record keeping (SOAP notes, rehabilitation forms,
OTC charts) _______
4.2 Assists in maintaining an appropriately stocked and organized kit _______ 4.3 Assists in daily maintenance and stocking of the athletic training rooms _______ 4.4 Understands and utilizes the appropriate medical terminology _______ 4.5 Applies knowledge from the classroom to the clinical setting _______ 4.6 Demonstrates the ability to prepare for events and practices _______
V. Evaluation Skills
5.1 Obtains a pertinent history _______
5.2 Recognizes the difference between on field evaluations and clinical evaluations _______
5.3 Complies with the emergency action plan when necessary _______
5.4 Correctly palpates the area _______
5.5 Performs special tests with confidence and understanding _______ 5.6 Accurately determines the results of a lower extremity evaluation _______ 5.7 Accurately determines the results of an upper extremity evaluation _______
VI. Treatment
6.1 Demonstrates appropriate emergency first aid skills _______
6.2 Complies with OSHA guidelines _______
6.3 Chooses the proper taping and/or bracing technique _______
6.4 Applies taping and bracing techniques efficiently and effectively _______
6.5 Demonstrates the ability for proper wound management _______
6.6 Provides safe and effective initial injury management _______
X. Please list areas needing improvement.
XI. Please indicate ways that this student can improve.
This is to acknowledge that I have seen and discussed its contents with the evaluator. Student’s Signature _____________________ Date ___________________ Preceptor’s Signature ___________________ Date ___________________
information below and make an appointment with your clinical preceptor to discuss any questions regarding the content of this form. After reviewing and understanding all the information contained in this form, please sign and return to the Clinical Education Coordinator. This form will be retained in your permanent academic file within the Athletic Training Program. These forms will be completed at mid-rotation and at the end of each clinical rotation to assist in measuring student progress.
Student Name: Clinical Preceptor:
Sport Assignment: Date of Rotation:
Student Evaluation
Please assign the number that best applies to the statement regarding the athletic training student. Please leave any question that is not applicable to your situation blank.
KEY
1-Seldom 2-Occasionally 3-Fairly Often 4-Almost Always 5-Always
I. Administration/Professionalism
1.1. Demonstrates punctuality and dependability _______
1.2 Dresses appropriately _______
1.3 Demonstrates professionalism with athletes _______
1.4 Demonstrates professionalism with coaches and other athletic trainers _______
1.5 Adheres to athletic training room procedures _______
1.6 Maintains a balance between personal and professional relationships _______
1.7 Assists in preparation for games and practices _______
1.8 Cooperates with other athletic training students _______
1.9 Demonstrates emotional maturity and effective coping skills _______ 1.10 Demonstrates overall awareness during the games and practices _______ 1.11 Understands and demonstrates knowledge of event management _______ 1.12 Understands current limitations and seeks assistance when necessary _______
II. Methods for Improving Skills
2.1 Receives and responds to constructive criticism _______
2.2 Displays an eagerness to learn and asks questions _______
2.3 Mentors 1st year students and observation students _______
2.4 Takes an active role in learning _______
2.5 Accepts responsibility _______
2.6 Conveys respect for the clinical instructor’s opinion _______
2.7 Conveys respect for other athletic training students’ opinions _______
III. Communication Skills
3.1 Speaks clearly with tact and discretion _______
3.2 Communicates in an organized logical manner _______
3.3 Recognizes the effects of non-verbal communication _______
3.4 Exhibits confidence with skills and knowledge _______
3.5 Communicates daily with the supervising clinical instructor _______
immediate vicinity is not necessary.
2-Student requires supervision from the clinical instructor. Student needs verbal cueing or physical
assistance from the clinical instructor.
1-Student requires constant supervision from the clinical instructor and cannot accomplish the task
without the instructor.
N/A-Not applicable N/O-Not observed
IV. Administration Skills
4.1 Demonstrates and maintains accurate record keeping (SOAP notes, rehabilitation forms,
OTC charts) _______
4.2 Assists in maintaining an appropriately stocked and organized kit _______ 4.3 Assists in daily maintenance of the athletic training rooms _______ 4.4 Understands and utilizes the appropriate medical terminology _______ 4.5 Applies knowledge from the classroom to the clinical setting _______ 4.6 Demonstrates the ability to prepare for events and practices _______
V. Evaluation Skills
5.1 Obtains a pertinent history _______
5.2 Recognizes the difference between on field evaluations and clinical evaluations _______ 5.3 Complies with the emergency action plan when necessary _______
5.4 Correctly palpates the area _______
5.5 Performs special tests with confidence and understanding _______ 5.6 Accurately determines the results of a lower extremity evaluation _______ 5.7 Accurately determines the results of an upper extremity evaluation _______ 5.8 Performs special tests for general medical conditions with confidence and _______
understanding
5.9 Accurately determines the results of a general medical evaluation _______
VI. Treatment
6.1 Demonstrates appropriate emergency first aid skills _______
6.2 Complies with OSHA guidelines _______
6.3 Chooses the proper taping and/or bracing technique _______
6.4 Applies taping and bracing techniques efficiently and effectively _______
6.5 Demonstrates the ability for proper wound management _______
6.6 Provides safe and effective initial injury management _______ 6.7 Sets goals for the athlete and recognizes the goals of the athlete _______
VII. Modalities
7.1 Actively participates in modality selection based on goals _______ 7.2 Demonstrates the ability to correctly set up and utilize various modalities _______
7.3 Demonstrates an understanding of modality parameters _______
7.4 Can develop a plan for modality usage as the athlete progresses _______
X. Please list areas needing improvement.
XI. Please indicate ways that this student can improve.
This is to acknowledge that I have seen and discussed its contents with the evaluator. Student’s Signature _____________________ Date ___________________ Preceptor’s Signature ___________________ Date ___________________
information below and make an appointment with your clinical preceptor to discuss any questions regarding the content of this form. After reviewing and understanding all the information contained in this form, please sign and return to the Clinical Education Coordinator. This form will be retained in your permanent academic file within the Athletic Training Program. These forms will be completed at mid-rotation and at the end of each clinical rotation to assist in measuring student progress.
Student Name: Clinical Preceptor:
Sport Assignment: Date of Rotation:
Student Evaluation
Please assign the number that best applies to the statement regarding the athletic training student. Please leave any question that is not applicable to your situation blank.
KEY
1-Seldom 2-Occasionally 3-Fairly Often 4-Almost Always 5-Always
I. Administration/Professionalism
1.1. Demonstrates punctuality and dependability _______
1.2 Dresses appropriately _______
1.3 Demonstrates professionalism with athletes _______
1.4 Demonstrates professionalism with coaches and other athletic trainers _______
1.5 Adheres to athletic training room procedures _______
1.6 Maintains a balance between personal and professional relationships _______
1.7 Assists in preparation for games and practices _______
1.8 Cooperates with other athletic training students _______
1.9 Demonstrates emotional maturity and effective coping skills _______ 1.10 Demonstrates overall awareness during the games and practices _______ 1.11 Understands and demonstrates knowledge of event management _______ 1.12 Understands current limitations and seeks assistance when necessary _______
II. Methods for Improving Skills
2.1 Receives and responds to constructive criticism _______
2.2 Displays an eagerness to learn and asks questions _______
2.3 Mentors 1st year students and observation students _______
2.4 Takes an active role in learning _______
2.5 Accepts responsibility _______
2.6 Conveys respect for the clinical instructor’s opinion _______
2.7 Conveys respect for other athletic training students’ opinions _______
III. Communication Skills
3.1 Speaks clearly with tact and discretion _______
3.2 Communicates in an organized logical manner _______
3.3 Recognizes the effects of non-verbal communication _______
3.4 Exhibits confidence with skills and knowledge _______
3.5 Communicates daily with the supervising clinical instructor _______
immediate vicinity is not necessary.
2-Student requires supervision from the clinical instructor. Student needs verbal cueing or physical
assistance from the clinical instructor.
1-Student requires constant supervision from the clinical instructor and cannot accomplish the task
without the instructor.
N/A-Not applicable N/O-Not observed
IV. Administration Skills
4.1 Demonstrates and maintains accurate record keeping (SOAP notes, rehabilitation forms,
OTC charts) _______
4.2 Assists in maintaining an appropriately stocked and organized kit _______ 4.3 Assists in daily maintenance of the athletic training rooms _______ 4.4 Understands and utilizes the appropriate medical terminology _______ 4.5 Applies knowledge from the classroom to the clinical setting _______ 4.6 Demonstrates the ability to prepare for events and practices _______
V. Evaluation Skills
5.1 Obtains a pertinent history _______
5.2 Recognizes the difference between on field evaluations and clinical evaluations _______ 5.3 Complies with the emergency action plan when necessary _______
5.4 Correctly palpates the area _______
5.5 Performs special tests with confidence and understanding _______ 5.6 Accurately determines the results of a lower extremity evaluation _______ 5.7 Accurately determines the results of an upper extremity evaluation _______ 5.8 Performs special tests for general medical conditions with confidence and _______
understanding
5.9 Accurately determines the results of a general medical evaluation _______
VI. Treatment
6.1 Demonstrates appropriate emergency first aid skills _______
6.2 Complies with OSHA guidelines _______
6.3 Chooses the proper taping and/or bracing technique _______
6.4 Applies taping and bracing techniques efficiently and effectively _______
6.5 Demonstrates the ability for proper wound management _______
6.6 Provides safe and effective initial injury management _______ 6.7 Sets goals for the athlete and recognizes the goals of the athlete _______
VII. Modalities
7.1 Actively participates in modality selection based on goals _______ 7.2 Demonstrates the ability to correctly set up and utilize various modalities _______
7.3 Demonstrates an understanding of modality parameters _______
8.3 Participates in progressing rehabilitation programs _______ 8.4 Participates in educating the athlete regarding the treatment and rehabilitation plan _______
Total ______/120 Average Score (total points/30) =