From: brittney hardin brittney.hardin@gcsu.

edu
Subject: Fwd: Form submission from: KINS 3122: Preceptor Evaluation of Student
Date: July 6, 2018 at 12:41 PM
To: kayla brockway kayla.brockway@bobcats.gcsu.edu

Please see below.

Brittney Hardin, M.Ed., ATC, LAT

School of Health & Human Performance
Lecturer, Clinical Education Coordinator
Athletic Training Program
Campus Box 112
Health Science Building 325
Office: 478-445-8626

Think Independently. Lead Creatively.

Begin forwarded message:

From: Kayla Brockway <georgia.college@gcsu.edu>

Subject: Form submission from: KINS 3122: Preceptor Evaluation of Student
Date: July 6, 2018 at 12>38>54 PM EDT
To: <brittney.hardin@gcsu.edu>

Submitted on July 6, 2018 - 12:38pm

Submitted by anonymous user: [12.161.103.194]

Submitted values are:

INSTRUCTIONS

Please fill out the evaluation below. The survey will be emailed to the email address you provided on the survey. Please
printout the email. Both the student and preceptor need to sign and date the last page of the printout.

Student Name
Kayla Brockway

Preceptor Name
Regina Natera

Preceptor Email
rnatera@corahealth.com

Clinical Setting/Experience
Outpatient PT clinic

Date
July 6, 2018

Evaluation
Evaluation
Final Evaluation

DIRECTIONS

Please evaluate the athletic training student objectively. Please select the appropriate response for each item in the categories
below. Select NA if you are not able to assess the student. NA = Not Able to Assess 5 = Outstanding 4 = Good 3 =
Satisfactory 2 = Improvement Needed 1 = Unacceptable

Athletic Training Knowledge

NA 5 4 3 2 1

1. Demonstrates knowledge of policies and procedures of clinical experience X

setting.

2. Demonstrates knowledge in injury prevention. X

3. Demonstrates skill in selecting and interpreting fitness/testing procedures X

to minimize risk of injury/illness.

4. Demonstrates skill in developing and implementing prevention strategies to X

minimize risk of injury/illness.

5. Demonstrates knowledge in taping/bracing techniques. X

6. Demonstrates skill in applying taping/bracing techniques. X

7. Demonstrates knowledge in injury evaluation and diagnosis. X

8. Demonstrates knowledge in providing treatment to patients/athletes. X

Interpersonal Skills

NA 5 4 3 2 1

1. Demonstrates effective written communication with preceptor. X

2. Demonstrates effective oral communication with preceptor. X

3. Demonstrates effective communication with patients/athletes. X

4. Demonstrates effective communication with other staff/personnel. X

5. Demonstrates effective critical-thinking skills. X

6. Demonstrates effective clinical decision-making skills. X

7. Demonstrates a positive attitude in interactions with preceptor, patients, X

etc.

8. Demonstrates confidence in abilities as an athletic training student. X

Professional Responsibility

NA 5 4 3 2 1

1. Demonstrates punctuality. X
 2. Demonstrates professionalism (i.e., attitude, actions, dress/appearance). X

3. Demonstrates initiative. X

4. Demonstrates a willingness to learn. X

5. Demonstrates an awareness of limitations. X

6. Maintains confidentiality. X

DIRECTIONS

Please evaluate the athletic training student objectively. Please select the appropriate response for each item in the categories
below. Select NA if you are not able to assess the student. NA = Not Able to Assess 5 = Outstanding 4 = Good 3 =
Satisfactory 2 = Improvement Needed 1 = Unacceptable

Administrative Tasks

NA 5 4 3 2 1

1. Demonstrates an ability to multi-task efficiently and effectively. X

2. Maintains an accurate inventory of supplies. X

3. Maintains accurate documentation of injuries/illnesses and treatments X

provided.

4. Documents injuries/illnesses and treatments accurately. X

5. Utilizes accurate and appropriate medical terminology. X

Technical Standards

NA 5 4 3 2 1

1. Demonstrates the mental capacity to assimilate, analyze, synthesize, X

integrate concepts and problem solve to formulate assessment and
therapeutic judgments.

2. Demonstrates sufficient postural and neuromuscular control, sensory X

function, and coordination to perform appropriate physical examinations
using accepted techniques.

3. Demonstrates the ability to tolerate physically taxing work loads. X

4. Demonstrates the ability to communicate effectively and sensitively with X

patients and colleagues, including individuals from different cultural and social
backgrounds.

5. Demonstrates the ability to record the physical examination results and a X

treatment plan clearly and accurately.

6. Demonstrates the capacity to maintain composure and continue to function X

well during periods of high stress.

7. Demonstrates the perseverance, diligence and commitment to complete X

 7. Demonstrates the perseverance, diligence and commitment to complete X
the athletic training program as outlined and sequenced.

8. Demonstrates flexibility and the ability to adjust to changing situations and X

uncertainty in clinical situations.

9. Demonstrate affective skills and appropriate demeanor and rapport that X

relate to professional education and quality patient care.

Upper Extremity Assessment Skills

NA 5 4 3 2 1

1. Obtains appropriate medical history. X

2. Completes appropriate visual observation of upper extremity X

injury/condition.

3. Identifies and palpates appropriate upper extremity anatomical landmarks. X

4. Assesses upper extremity range of motion appropriately. X

5. Performs upper extremity manual muscle test(s) appropriately. X

6. Selects appropriate diagnostic/special tests pertinent to injury/condition. X

7. Performs upper extremity diagnostic/special tests accurately. X

8. Differentiates between normal and abnormal patient physical findings. X

9. Performs appropriate upper extremity neurological circulatory assessment. X

10. Documents evaluation and diagnosis appropriately. X

Therapeutic Rehabilitation Skills

NA 5 4 3 2 1

1. Selects appropriate goals for patients. X

2. Inspects therapeutic rehabilitation equipment prior to use for safety. X

3. Utilizes appropriate therapeutic exercises based on patient goals. X

4. Demonstrates proper technique of rehabilitative exercises. X

5. Utilizes functional progression and functional testing appropriately. X

6. Documents rehabilitation goals and functional progression appropriately. X

GLOBAL ASSESSMENT

In the space below, please assess the athletic training in each of the following areas:

Willingness to accept role as a health care provider:

Student is motivated to gain more knowledge, to be able to provide good patient care skills. She is motivated to gain better
 Student is motivated to gain more knowledge, to be able to provide good patient care skills. She is motivated to gain better
understanding of pt's needs and concerns.

Utilization of evidence-based medicine techniques in patient care:

Student has a great understanding on athletic injuries, including special tests, treatment plans, and progression of healing
time.

Strengths of the athletic training student:

Willingness to learn, building patient rapport, flexibility, and compassion.

Areas for the athletic training student to improve:

see below

Additional comments:
Kayla has progressed through her clinical rotation nicely. Kayla will need to continue to learn on variety of physical therapy
diagnosis, physiological conditions, and progression for all. Based on treatment setting, student was not able document on
her pt's, however demo'd good written documentation to PT regarding cueing, changes in treatment, and pt response to
treatment. Kayla demonstrated increased confidence in her knowledge skills, will continue to improve on her ability to
confidently explain treatment, modalities, and rationale for exercise programs. Kayla can improve on showing initiate during
downtime, and understand pt's thought process for not wanting to be seen by student vs PT. Kayla demonstrated ability to
handle one-two pt/hour caseload. Based on setting, will continue to require improvement in handling 3-4 pt caseload/hour,
including documentation, and treatment of pt's based on insurance needs. Due to large Spanish speaking population, Kayla
unable to fully communicate with some of our patients, mild frustration; however motivated to improve her ability to learn
Spanish if she stays in Florida. Overall, good clinical rotation, helpful as a student.

Do you feel students under your supervision engage in a sufficient number of real-time clinical evaluations? Why or Why Not?
n/a

Signature
__________________________________________ Student Signature / Date

The results of this submission may be viewed at:

https://intranet.gcsu.edu/node/1603/submission/14846