Massachusetts college of pharmacy & health sciences radiation therapy program school of Medical Imaging & Therapeutics Contact Information



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Final Semester Evaluation



Policy
The Supervisor’s Evaluation of Clinical Skills final clinical evaluation is a comprehensive assessment of the student’s clinical comprehension, technical skills, patient care skills, and professionalism. The student is responsible for reviewing the final evaluation along with course objectives at the beginning of every rotation to ascertain what clinical skills and behaviors will be evaluated by the therapy staff.
Procedure
1. It is the student’s responsibility to provide the staff with the document one week prior to the due date.

2. It is preferred by the faculty that all staff therapists working with the student on the treatment unit have input in the evaluation of the student.

4. The lead therapist or clinical supervisor is responsible for reviewing the final evaluation with the student.

5. It is the student’s responsibility to forward this document to the Clinical Coordinator by the due date.

6. If staff prefers, **This document does NOT have to be reviewed with the student**. The Clinical Coordinator would be happy to review this evaluation with the student.

7. A student who debates a grade with the clinical staff will have a clinical infraction and/or program disciplinary actions based on the severity of behaviors

8. An electronic copy of the final evaluation form should be e-mailed to the Clinical Coordinator by the clinical staff. No final evaluations will be accepted by the Clinical Coordinator from the student directly.

Revised 6/10

SUPERVISOR EVALUATION OF CLINICAL SKILLS

Massachusetts College of Pharmacy and Health Sciences



Radiation Therapy Program

SUPERVISOR EVALUATION OF CLINICAL SKILLS


Comprehensive Program Evaluation Protocol

Class of 2011, Class of 2012




Clerkship RTT 201C, RTT 202C, RTT 203C, RTT 304C, RTT 305C



Internship #: 1 2 3 4 5


Student Name:


Internship Site:

Clinical Supervisor Name:

Date:




Clinical Supervisor Instructions: Please read the narratives associated with each letter grade. After reading the narrative and taking into consideration this student’s performance compared to others at the same stage of training, assign a rank on the scale that best describes the student’s level of performance.
SECTION 1: CLINICAL COMPETENCY

1) Written Communications Clinical Competency Intent Form *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Failed to submit Intent Form. Failed to identify goals or relevant information. Frequently needed cueing or discussions around identifying or completing goals.

Entries disorganized, failing to identify goals or relevant information. Fails to review with staff by the end of the first

week of clinical. Not initiated by

student.


Disorganized with exclusion of relevant data. Goal directed with most relevant information provided. Reviewed by the end of the first week of clinical, not initiated by the student.

Organized, concise, goal directed with most relevant information provided.

Reviewed by the end of the first week of clinical and initiated by the student.



Well organized, concise, goal directed & relevant information. Reviewed by the end of the first week of clinical and initiated by the student.

*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A


2) Warm-up Procedure (Comprehensive and Machine Specific) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Incomplete and inconsistent with major deficiencies in technical quality. Inability to pass after three attempts.


Completed with minor deficiencies in technical quality. Able to pass after 1-3 attempts.

Occasionally incomplete or inconsistent with minor deficiencies in technical quality. Attention to organization and speed indicated.

Appropriate skills evaluated. Good organizational flow with an understanding of procedure.

Appropriate skills evaluated with description of procedure. Well organized flow and knowledge base.

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F

D

C-

C

C+

B-

B

B+

A-

A


3) Written Conference Communications *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY

*exclusions due to scheduled log-ins only


Fails to submit entries or documentation of conference. Fails to identify topic for review. Less than 25% of conferences attended or failed to attend any conferences.

Entries disorganized with inclusion of extraneous information. Fails to identify topic for review. Less than 50% of conferences attended.

Occasionally disorganized with exclusion of relevant data, some inclusion of extraneous data. Minor revisions indicated. 50–75% of conferences attended.

Organized with inclusion of relevant data and exclusion of extraneous information.

Reviewed on date of conference. 75%-90% of conferences attended.




Well organized, concise presentation of relevant information. Reviewed on the date of conference. 100% of conferences attended.

*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A



STUDENT: _______________________________________
4) Technical Skills/Clinical Competency Procedures *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Procedures accomplished using unsafe technique; consistently fails to organize equipment ahead of time; has not consistently mastered procedures & clinical set ups. Inability to master documentation & in making adjustments in field parameters.

Procedures accomplished using improper technique; fails to organize equipment ahead of time; difficulty in timing & coordination. Major difficulty in mastering procedure & clinical set ups. Major difficulty with documentation & making adjustments in field parameters


Procedures generally accomplished using proper technique, but occasionally fails to organize equipment; minor problems with timing and coordination. Some difficulty with documentation & in making adjustments in field parameters.

Procedures performed using proper technique; equipment organized ahead of time; coordination and timing of procedure appropriate. Adequate in documentation & in making adjustments in field parameters.

Procedures performed using proper technique; equipment organized ahead of time; coordination and timing of procedure precise and without hesitation. Proficient in documentation & in making adjustments in field parameters

*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A


5) Technical Skills/Routine Clinical Procedures *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Procedures accomplished using unsafe technique; consistently fails to organize equipment ahead of time; has not consistently mastered procedures & clinical set ups. Inability to master documentation & in making adjustments in field parameters.

Procedures accomplished using improper technique; fails to organize equipment ahead of time; difficult timing and coordination, difficulty mastering new skills or procedures. Some difficulty with documentation & in making adjustments in field parameters.


Procedures generally accomplished using proper technique, but occasionally fails to organize equipment; minor problems with timing and coordination. Some difficulty with documentation & in making adjustments in field parameters.

Procedures performed using proper technique; equipment organized ahead of time; coordination and timing of procedure appropriate. Masters new skills easily. Adequate in documentation & in making adjustments in field parameters.

Procedures performed using proper technique; equipment organized ahead of time; coordination and timing precise; masters new skills with great facility. Proficient in documentation & in making adjustments in field parameters.

*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A


6) Technical Skills/Recompetency Clinical Procedures *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Recompetency procedures accomplished using unsafe technique. Demonstrates failure in maintenance of clinical skills & procedures. Inadequate knowledge & comprehension of concepts required for procedure.

Recompetency procedures accomplished using improper technique. Demonstrates difficulty in maintenance of clinical skills & procedures. Poor knowledge & comprehension of concepts required for procedure.


Recompetency procedures generally accomplished using proper technique, Demonstrates some inconsistency in maintenance of clinical skills & procedures. Fair knowledge & comprehension of concepts required for procedur.e

Recompetency procedures performed using proper technique; Demonstrates maintenance of clinical skills & procedures; Good knowledge & comprehension of concepts required for procedure.

Recompetency procedures performed using proper technique, & with great facility; Demonstrates mastering & maintenance of clinical skills & procedures. Excellent knowledge & comprehension of concepts required for procedure.

*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A



7) DOSIMETRY/TREATMENT PLANNING (To be filled out by dosimetry staff members only) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Great difficulty recalling and comprehending basic treatment planning procedures. Has not mastered new skills or procedures. Needs foundation of knowledge base. Lacks initiative in rotation & education.



Difficult recalling and comprehending basic treatment planning procedures. Difficulty mastering new skills or procedures. Needs improved knowledge base. Needs improvement in initiative in rotation & education.

Occasional difficulty recalling and comprehending basic treatment planning procedures. Minor difficulty mastering new skills, or documentation. Usually demonstrates initiative in rotation & education.

Recalls, comprehends and relates knowledge of basic treatment planning procedures. Masters new skills easily. Proficient in documentation. Demonstrates initiative in rotation & education.

Demonstrates advanced comprehension and application of basic treatment planning procedures. Masters new skills with great facility. Proficient in documentation. Excellent initiative in rotation & education.

*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A



NAME OF STUDENT: _______________________________________
8) SIMULATION: Please note: (level of participation may depend on state or institutional requirements) –the following levels of student participation is acceptable: perform, discuss, review, or observe simulation procedure & competency. All simulation procedures must be demonstrated on patients (not on phantoms).


Great difficulty recalling and comprehending basic simulation planning procedures. Has not mastered new skills or procedures, use of equipment. Needs foundation of knowledge base. Lacks initiative in rotation & education.


Difficult recalling and comprehending basic simulation planning procedures. Difficulty mastering new skills or procedures, use of equipment. Needs improved knowledge base. Needs improvement in initiative in rotation & education.

Occasional difficulty recalling and comprehending basic simulation planning procedures. Minor difficulty mastering new skills, use of equipment or documentation. Usually demonstrates initiative in rotation & education.

Recalls, comprehends and relates knowledge of basic simulation planning procedures. Masters new skills easily. Proficient in use of equipment & documentation. Demonstrates initiative in rotation & education.

Demonstrates advanced comprehension and application of basic simulation planning procedures. Masters new skills with great facility. Proficient in use of equipment & documentation. Excellent initiative in rotation & education.

*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A


9) Industry and Attitude towards Work (Self Management) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Inefficient use of time. Wastes time in unproductive activities. Has trouble meeting commitments. Lacks initiative and needs frequent reminders. Lacks initiative in rotation & education.


Generally ineffective use of time. Somewhat productive and usually uses time to meet most commitments. Occasionally takes initiative for extra work. May need reminders. Needs improvement in initiative in rotation & education.

Occasional ineffective use of time. Reasonably productive and uses time to meet most commitments. Usually takes initiative for extra work. Generally does not need reminders. Usually demonstrates initiative in rotation & education.

Effective use of time; performs assigned duties and attends to commitments without being reminded. Takes initiative for extra work. Demonstrates initiative in rotation & education.


Functions efficiently with minimal direction. Performs all duties and seeks additional assignments. Always seeks additional work. Excellent initiative in rotation & education.

*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A


10) Interpersonal Interactions with Patients *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Lacks communication skills; (verbal and nonverbal). Cannot adequately explain things & is not aware of cross cultural situations; often does not listen to patients or is superficial. Lacks empathy and therapeutic skills.

Demonstrates difficulty at times communicating and explaining things, occasionally aware of cross cultural situations; usually listens to patients. Usually empathetic and therapeutic.

Attempts to communicate and explains appropriately & generally aware of cross cultural situations. Generally listens to patients. Generally empathetic and therapeutic.

Communicates effectively; offers appropriate explanations while being aware of cross cultural situations; listens attentively to patients. Empathetic and therapeutic.

Communicates very effectively; makes extra effort to offer explanations while being astuitely aware of cross cultural situations; listens attentively even with difficult patients. Always empathetic and therapeutic.

*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A


SECTION 2: CRITICAL THINKING

1) Knowledge Assessments (Comprehensive and Case Specific due 1 week prior to competency) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY



Consistently inaccurate or incomplete with major or minor data frequently missing. (Not submitted prior to competency). Needs improvement and/or

remediation.




Incomplete or inaccurate with important major or minor data frequently missing. Lack of chronology of events (Not always submitted prior to competency). Needs minor improvement.

Occasionally incomplete or inaccurate with minor details missing. Attention to chronology and detail needed.

Less complete and accurate with important data on chronology of events included.

Complete and accurate with important data on chronology of events obtained in efficient, concise fashion.

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F

D

C-

C

C+

B-

B

B+

A-

A


NAME OF STUDENT: _______________________________________
2) Oral Competency Communications (Case Discussions) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Case presentations missed or rescheduled frequently due to lack of preparation. Disorganized, poorly integrated and confusing. Unable to explain or summarize.

Case presentations are disorganized, poorly integrated and confusing. Unable to explain or summarize. Competency rescheduled by staff due to student’s lack of knowledge.

Case presentations generally organized but occasionally verbose, incomplete or confusing. Additional data required in order to pass.

Case presentations are organized and complete. Able to explain and summarize effectively. Good knowledge base of information.

Case presentations are complete, concise, orderly and succinct. Able to explain and summarize effectively. Excellent knowledge base of information.

*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A


3) PROBLEM SOLVING & CRITICAL THINKING ABILITY

Fundamentals and Application of Knowledge *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Great difficulty recalling and comprehending basic radiation therapy knowledge. Inadequate preparation and/or lack of clinical preparation. Needs foundation of knowledge base. Lacks ability to recall previously learned information.

Difficult recalling and comprehending basic radiation therapy knowledge. Inadequate pre-clinical preparation. Needs improved knowledge base. Needs improvement in ability to recall previously learned information.


Occasional difficulty recalling and comprehending basic radiation therapy knowledge. Usually demonstrates ability to recall previously learned information.

Recalls, comprehends and relates knowledge of basic radiation therapy sciences to clinical cases. Demonstrates ability to recall previously learned information.

Demonstrates advanced comprehension and application of basic radiation therapy sciences to clinical cases. Excellent demonstration of ability to recall previously learned information.

*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A

4) Clinical Research Assignment OR patient CASE PRESENTATION (THIS IS NOT THE ORAL COMPETENCY) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY



Disorganized presentation of information & data or no presentation of information submitted. Work not cited or cited and referenced improperly.

Disorganized presentation of information & data. Work cited inconsistently or not in proper format.


Occasionally disorganized presentation with most relevant information & data. Work cited and referenced properly.


Organized, presentation with inclusion of relevant information & data. All work cited and referenced properly.


Well organized, concise presentation of all relevant information & data. All work cited and referenced properly.


*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A


SECTION 3: PROFESSIONALISM

1) Personal Attitudes

Attitude Toward Learning (Self-Learning) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Assimilates information passively and indifferently or not at all.

Infrequently attends or does not attend lectures or conferences. Lacks knowledge of radiation therapy.




Assimilates information passively and indifferently; infrequently attends lectures, conferences. Occasionally lacks knowledge of radiation therapy.

Occasionally shows interest, asks questions; occasionally attends lectures and conferences. Generally demonstrates knowledge of radiation therapy.

Expends extra effort to read on problems encountered; asks good questions; attends lectures and conferences; demonstrates knowledge of radiation therapy.

Demonstrates independent learning effort; undertakes supplemental readings; is questioning, insightful and enthusiastic. Excellent initiative.

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F

D

C-

C

C+

B-

B

B+

A-

A


NAME OF STUDENT: _______________________________________
2) Interpersonal Interactions with Health Professionals *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Fails to cooperate with others; does not recognize own limitations, does not accept & learn from constructive criticism; consistently oversteps boundaries with other health professionals, and fails to respect others' professional roles.

Usually cooperates with other health professionals; occasionally fails to recognize own limitations, needs improvement on accepting & learning from constructive criticism; may occasionally overstep boundaries with other health professionals, or respecting others' professional roles.

Generally cooperates with other health professionals; usually recognizes own limitations, usually accepts & learns from constructive criticism; and generally respects others’ professional roles.

Cooperates with other health professionals; recognizes own limitations, accepts & learns from constructive criticism; and respects others' professional roles.

Expends extra effort to cooperate with other health professionals; recognizes own limitations, always accepts & learns from constructive criticism; respects and complements others' professional roles.

*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A


3) Professional Judgment *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Unresponsive to criticism; proceeds on own without checking with authority; overestimates abilities; poor judgment.


Occasionally unresponsive or defensive about criticism, usually fails to check with authority before proceeding; occasionally lacks good judgment.

Generally responsive to criticism; occasionally fails to check with authority before proceeding;

usually demonstrates good judgment.




Responds readily to criticism; checks routinely before proceeding; seeks assistance when approaching limits of ability; demonstrates appropriate judgment.

Seeks out feedback on performance from other health professionals; recognizes own limitations; demonstrates good judgment.

*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A


4) Clinical Attendance *Please Note: Students are allowed one excused absence without effecting their grade. **attendance record must be consulted before completing this portion! *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Greater than 4 clinical absences requiring numerous make up day(s). and/or not punctual to clinical and conferences. Exceeded limit of scheduled breaks or lunch hour. Did not call Clinical Supervisor/staff if absent.

Had 3 clinical absences requiring make up day(s). Usually punctual to clinical and conferences with occasional tardiness. Occasionally exceeded limit of scheduled breaks or lunch hour. Often did not call Clinical Supervisor/staff if absent.

Had 2 clinical absences requiring make up day(s). Generally punctual to clinical and conferences. Generally did not exceed limit of scheduled breaks or lunch hour. Occasionally called Clinical Supervisor/staff if absent.

Had 1 clinical absence requiring make up days. Punctual to clinical and conferences. Did not exceed limit of scheduled breaks or lunch hour. Called Clinical Supervisor/staff if absent.

Attended all scheduled clinical days. Always punctual to clinical and conferences. Did not exceed limit of scheduled breaks or lunch hour. Called Clinical Supervisor/staff if absent.

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F

D

C-

C

C+

B-

B

B+

A-

A


5) Rules & Regulations (Dress code, Ethics & Professional Conduct) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Often demonstrates inappropriate behavior, not always committed to ethical standards, unprofessional demeanor demonstrated. Dependable and responsible behavior not always

demonstrated.



Occasional inappropriate behavior, usually committed to ethical standards, professional demeanor. Generally dependable & responsible behavior.

Appropriate behavior, generally committed to ethical standards, professional demeanor, dependable & responsible behavior.

Appropriate behavior, demonstrates commitment to ethical standards. Professional demeanor, dependable & responsible behavior.

Exceptional behavior, always demonstrates commitment to ethical standards. Professional demeanor, dependable & responsible behavior.

*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A

NAME OF STUDENT: _______________________________________
6) Written Communication with Clinical Coordinator (submission of weekly e-journals & submission of all required clinical documentation) To be Evaluated by Clinical Coordinator at MCPHS *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY


Entries disorganized with inclusion of extraneous information. Fails to submit more than 50% of the time and/or not at all. Not submitted electronically.

Entries disorganized with inclusion of extraneous information. Fails to identify requested information. Not submitted on time at least 50% of time and/or not submitted electronically.

Occasionally disorganized with exclusion of relevant data, some inclusion of extraneous data. Generally submitted electronically and on time.

Organized with inclusion of relevant data and exclusion of extraneous information. Generally submitted electronically and on time.

Well organized, concise presentation of relevant information. Submitted electronically and on time.

*PLEASE CIRCLE ONE

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F

D

C-

C

C+

B-

B

B+

A-

A


7) Clinical Infraction (written policy infractions submitted by Clinical Supervisor and/or Clinical Coordinator (Check one section only). Four or more clinical infractions will result in a drop of one letter grade for that clinical internship.

Four or more Clinical Infractions of the RTT program policies


Three Clinical Infractions of the RTT program policies


Two Clinical Infractions of the RTT program policies


One Clinical Infraction of the RTT program policies


No Clinical Infractions of the RTT program policies




















SECTION 4

1A) Clinical Procedure Lab: Section to be filled out by the Clinical Procedure Lab Adjunct Faculty & Clinical Coordinator only.

2A) Research Assignment: Section to be filled out by the Clinical Coordinator only

3A) Comprehensive Clinical Exam: Section to be filled out by the Clinical Coordinator only

















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F

<66

D

66-69


C-

70-72


C

73-76


C+

77-79


B-

80-82


B

83-86


B+

87-89


A-

90-92


A

93-100



Please take a minute to add comments. The Clinical Excellence Award is based on overall clinical performance.

Evaluator’s General Comments:
















ELECTRONIC SIGNATURE: (script or typed):
Chief Therapist/ Clinical Supervisor’s Signature: DATE:















For MCPHS Use Only:


SECTION 1

CLINICAL COMPETENCY

SECTION 2

CRITICAL THINKING

SECTION 3

PROFESSIONALISM

SECTION 4

PROCEDURE LABS (201C/202C)

RESEARCH ASSIGNMENT 203C, 304C

COMPREHENSIVE

EXAM 305C




40%

30%

20%

10%




Average for Section 1:

Average for Section 2:

Average for Section 3:







The final grade is calculated at the College, please do not tell the student what you think their grade will be.

************************************************************************************************

Please complete this document and make a copy for your records. Send electronically by the final Friday of the internship. Please do not give the evaluation to the student to deliver. Any questions please call Susan MacIsaac at 617-732-2840, or Susan Belinsky, Program Director at 617-732-2261.
The Program Director and the Clinical Coordinator reserves the right to review and change content of this form only in the case of major disagreement between MCPHS Program Officials and the Clinical Supervisor.

Revised 8/07, 1/08, 6/09, 12/09, 8/10, Reviewed 8/11




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