From: mandy jarriel mandy.jarriel@gcsu.

edu
Subject: Fw: Form submission from: KINS 4112: Preceptor Evaluation of Student
Date: April 17, 2019 at 4:12 PM
To: kayla brockway kayla.brockway@bobcats.gcsu.edu

Mandy Jarriel PhD, ATC, LAT, CHES

School of Health and Human Performance
Associate Professor, Program Director
Athletic Training Program
Campus Box 112
Health Sciences Building 330
OfGice: 478-445-2136

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

Sent: Wednesday, April 17, 2019 3:44 PM
To: mandy jarriel
Subject: Form submission from: KINS 4112: Preceptor EvaluaPon of Student

Submitted on April 17, 2019 - 3:44pm

Submitted by anonymous user: [70.191.134.56]

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
 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
Amanda Windon

Preceptor Email
amanda.windon@mountdesales.net

Clinical Setting/Experience
Mount de Sales

Date
April 17, 2019

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 to X

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 =
 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 the X

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.

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 Practice Skills

NA 5 4 3 2 1

1. Demonstrates appropriate knowledge and skill in injury/illness prevention X

and wellness protection.

2. Demonstrates appropriate knowledge and skill in clinical evaluation of X

injuries/illness.

3. Demonstrates appropriate knowledge and skill in immediate and emergency X

care of injuries/illnesses.

4. Demonstrates appropriate knowledge and skill in therapeutic interventions X

(e.g. modalities, rehabilitation, pharmacology).

5. Demonstrates appropriate knowledge and skill in organization and X

professional health.

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

She's very professional when it comes to treating patients. I feel that Kayla has accepted her role
as a healthcare provider and will be very successful in the healthcare field.

Utilization of evidence-based medicine techniques in patient care

Kayla brings evidence-based practices to the athletic training room regularly which helps me out
a ton to stay up to date

Strengths of the athletic training student

Very knowledgeable when it comes to special tests and evaluations of athletic injuries and the
proper treatments going forward.

Areas for the athletic training student to improve

 Areas for the athletic training student to improve
Don't doubt yourself.

Additional comments
Continue to do great! You will be an incredible athletic trainer and clinician.

Do you feel students under your supervision engage in a sufficient number of real-time
clinical evaluations? Why or Why Not?
yes. because i have soft kids.

Signature
__________________________________________ Student Signature / Date

The results of this submission may be viewed at:

https://intranet.gcsu.edu/node/1585/submission/15425