5/27/2015

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TouroUniversityNevada
OccupationalTherapy
TraineeEvaluation
Evaluator:

RyanBurneoFieldwork
Educator

Subject:

DaniellePalmerLevelI

Activity:

OCCT630A

Site:

HealthSouthDesertCanyonRehabilitationHospital
(Corporate:HealthSouthRehabilitationHospital)

Evaluation
Type:

EducatorEvaluationof
LevelIFieldworkStudent

Completion 05/27/2015
Date:

RequestDate:

05/05/2015

Period:

OCCT630ASpring2015

Subject
Participation
Dates:

04/27/2015To05/22/2015

Datesof
Activity:

04/27/2015To05/22/2015

FieldworkEducator:(Question1of7)
RyanBurneo

TypeofFieldwork:(Specialty/PracticeArea)(Question2of7Mandatory)

Selection

Option

1.1InPatientAcute

1.2InPatientRehab

1.3SNF/SubAcute/AcuteLongTermCare

1.4GeneralRehabOutpatient

1.5OutpatientHands

1.6PediatricHospital/Unit

1.7PediatricHospitalOutpatient

1.8InPatientPsych

2.1PediatricCommunity

2.2BehavioralHealthCommunity

2.3OlderAdultCommunityLiving

2.4OlderAdultDayProgram

2.5Outpatient/handprivatepractice

2.6AdultDayProgramforDD

2.7HomeHealth

2.8PediatricOutpatientClinic

3.1EarlyIntervention

3.2School

Other(seebelow)

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Other(Question3of7)

IfOtherwasselectedforTypeofFieldwork,pleasespecify:

Indicatethestudentslevelofperformanceusingthescaleprovided
4Exceeds
Standards:
3Meets
Standards:
2Below
Standards:
1WellBelow
Standards:

Frequentlycarriesouttasksandactivitiesthatsurpassrequirements.Attimes,performance
isexceptional.
Carriesoutrequiredtasksandactivities.Thisratingrepresentsgood,solidperformanceandis
typicallyusedmorethanalltheotherratings.
Opportunitiesforimprovementexisthowever,studenthasnotdemonstratedadequate
responsetofeedback.Workisoccasionallyunacceptable.
Performanceisweakinmostrequiredtasksandactivities.Workisfrequentlyunacceptable.

(Question4of7Mandatory)

Exceeds
Meets
Below
Standards Standards Standards

Well
Below N/A Comments
Standards

Considerabilitytosetpriorities,bedependable,
beorganized,followthroughwith
responsibilities

>>X<<

3.0

2.0

1.0

>>X<<

3.0

2.0

1.0

>>X<<

3.0

2.0

1.0

>>X<<

3.0

2.0

1.0

>>X<<

3.0

2.0

1.0

4.0

>>X<<

2.0

1.0

>>X<<

3.0

2.0

1.0

Organization

EngagementintheFieldwork
Experience
Considerthestudentsapparentlevelof
interest,levelofactiveparticipationwhileon
siteinvestmentinindividualsandtreatment
outcomesseekswaystoimproveself
performancefollowssafetyprecautions

SelfDirectedLearning
Considerabilitytotakeresponsibilityforown
learningdemonstratemotivationawareofown
strengthsandareasforimprovement

Reasoning/ProblemSolving
Considerabilitytouseselfreflection,willingness
toaskquestionsabilitytoanalyze,synthesize
andinterpretinformationunderstandtheOT
processdemonstratesinquiryskillsappropriate
tothestudentsstageofeducationandtraining

WrittenCommunication
Considergrammar,spelling,legibility,
successfulcompletionofwrittenassignments,
documentationskills

Initiative
Considerinitiative,abilitytoseekandacquire
informationfromavarietyofsources

ObservationSkills
Considerabilitytoobserverelevantbehaviors
forperformanceareasandperformance
componentsandtoverbalizeperceptionsand

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observations

VerbalCommunicationand
InterpersonalSkills
Considerabilitytointeractappropriatelywith
individuals(patients/clients/staff/caregivers)
suchaseyecontact,empathy,limitsetting,
respectfulness,useofauthoritydegree/quality
ofverbalinteractionsuseofbodylanguage
andnonverbalcommunicationexhibits
confidence

>>X<<

3.0

2.0

1.0

>>X<<

3.0

2.0

1.0

>>X<<

3.0

2.0

1.0

>>X<<

3.0

2.0

1.0

>>X<<

3.0

2.0

1.0

>>X<<

3.0

2.0

1.0

ProfessionalandPersonal
Boundaries
Considerabilitytorecognize/handle
personal/professionalfrustrationsbalance
personal/professionalobligationshandle
responsibilitiesworkwithotherscooperatively,
considerately,effectivelyresponsivenessto
socialcuesadherestoAOTACodeofEthics

UseofProfessionalTerminology
Considerabilitytorespectconfidentiality
appropriatelyapplyprofessionalterminology
(PracticeFramework)inwrittenandoral
communication

AttitudeandProfessional
Appearance
Considerabilitytomanagestressorsin
constructivewaysdemonstratesflexibilityas
requiredfollowsprogramguidelinesfordress
andhygiene

TimeManagementSkills
Considerabilitytobeprompt,arriveontime,
completeassignmentsontime

ParticipationintheSupervisory
Process
Considerabilitytogive,receiveandrespondto
feedbackseekguidancewhennecessary
followproperchannels

StudentLearningObjectivesforThisFieldworkExperience:
(Question5of7Mandatory)

Date
Completed

Student
LearningObjectives

1. 5/8/15

observeevaluation

2. 5/15/15

completenotedocumentation

3. 5/22/15

completedPOCforpatientlisteningthreeproblwmeareaandcomingupwith2
activitiesforeachproblemwhilegradingeachactivityup/down

FieldworkEducatorComments:(Question6of7)
Ptaskedappropriatequestionsandtookfeedbackverywell.Studentwaseagertolearnandwouldgohomeand
completedassignments,researchandquestionsforthefollowingweekeachtime

WehavebothreviewedtheEducatorEvaluationofStudent,StudentEvaluationofEducator,andStudent
EvaluationofFacility.(Question7of7Mandatory)
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Selection Option
Yes
X

No

ThepurposeofaLevelIFieldworkexperienceistoprovideanopportunityforexposuretooccupationaltherapy
interventionandprogrammingor,inthecaseswherenoOTservicesarecurrentlybeingprovided,exposureto
potentialgrowthareasforOT.Weencourageasmuchhandsonaspossibleandappropriatewithineach
experience.Itisexpectedthatprofessionalbehaviorsareupheldinallsettings.
Thankyouforyourparticipationinourprogramandyourassistanceintheeducationalprocessofour
occupationaltherapystudents.
PleasenotifytheAcademicClinicalCoordinatorimmediatelyifthisstudentisnotperformingtothefacilities
expectationsforLevelIFieldwork.
AshleyFechtOTD,OTR/L
AcademicClinicalCoordinator&AssistantProfessor
(702)7774762Office
(702)3701328Cell
ashley.fecht@tun.touro.edu
(AdaptedfromColoradoStateUniversityLevelIStudentPerformanceEvaluation,PhiladelphiaRegion
FieldworkConsortium,WashingtonUniversitySchoolofMedicinePrograminOccupationalTherapy)

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