Clinical Performance Evaluation of PHC Students - School of ...

University of Washington - School of Nursing - Student Clinical Performance Evaluation
Student:
Program:
Preceptor:
Agency:
Quarter: clinical quarter of clinical quarters
Instructions:
Please complete during the last week of the student’s clinical. Based on the student’s point of progression in the
clinical courses with the program, please use the following rating scale to describe the student’s clinical performance.
Comments and examples are especially helpful.
Rating Scale (check the appropriate number for each item):
1: Not satisfactory or unsafe.
2: Not always consistently satisfactory. Requires substantially more assistance than expected for point of progression
in program.
3: Consistently satisfactory or above satisfactory.
NA: Not applicable
1. Presentation of self to and interactions with clients, staff, and colleagues are
appropriate.
Comments/examples:
1 2 3 NA
2. Reviews salient client information prior to initiating visit. Uses appropriate
clinical resources wherever appropriate during visit.
Comments/examples:
1 2 3 NA
3. Interviewing skills include appropriate selection of technique for situation
(open questions, reframing, etc.), logical sequence of inquiry, and follow-up
on important leads. Avoids use of medical jargon and leading questions.
Comments/examples:
1 2 3 NA
4. Takes history appropriate to reason for visit containing all essential
elements.
Comments/examples:
1 2 3 NA
5. Performs indicated components of physical examination in timely manner
using correct technique.
Comments/examples:
1 2 3 NA
6. Selects and performs on-site labs and procedures correctly. Interprets
results accurately.
Comments/examples:
1 2 3 NA
7. Diagnostic assessments are consistent with the existing subjective and
objective data and, when appropriate, reflect use of differential diagnosis.
Comments/examples:
1 2 3 NA
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8. Plan of care reflects engagement of the client and other appropriate health prof
professions. Plan is complete, specific, and appropriate to diagnosis and client situation.
Comments/examples:
1 2 3 NA
9. Case presentations are succinct and use the correct format. 1 2 3 NA
Comments/examples:
10. Documentation is complete and uses appropriate terminology and format. 1 2 3 NA
Comments/examples:
11. Takes initiative for self learning. 1 2 3 NA
Comments/examples:
12. Demonstrates awareness of own limitations. Help-seeking is both
appropriate and timely.
Comments/examples:
1 2 3 NA
13. Recognizes potentially life-threatening situations and follows-up in an
appropriate manner.
1 2 3 NA
Comments/examples:
14. Demonstrates ability to accurately evaluate self. Uses self evaluation and
feedback from others to improve clinical performance.
Comments/examples:
1 2 3 NA
15. Overall clinical performance considering point of progression in program. Uses self
evaluation and feedback from others to improve clinical performance.
Comments/examples:
1 2 3 NA
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Areas of strength:
Areas to work on:
Evaluation completed by:
Printed name:
Date:
Student’s initials:
(indicates having read the evaluation)
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