From: mandy jarriel mandy.jarriel@gcsu.

edu
Subject: Fwd: Form submission from: KINS 3102: Preceptor Evaluation of Student
Date: October 11, 2017 at 11:01 PM
To: kayla.brockway@bobcats.gcsu.edu

Sent from my iPhone

Begin forwarded message:

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

Date: October 11, 2017 at 10:40:21 PM EDT
To: <mandy.jarriel@gcsu.edu>
Subject: Form submission from: KINS 3102: Preceptor Evaluation of Student

Submitted on October 11, 2017 - 10:40pm

Submitted by anonymous user: [10.90.80.139]
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
Caitlin Moeller

Preceptor Email
caitlin.moeller@gcsu.edu

Clinical Setting/Experience
GCSU RecSports

Date
October 11, 2017

Evaluation
Mid-term 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, etc. X

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 the X

athletic training program as outlined and sequenced.

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

uncertainty in clinical situations.

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

relate to professonal education and quality patient care.

Lower Extremity Assessment Skills

NA 5 4 3 2 1

1. Obtains appropriate medical history. X

2. Completes appropriate visual observation of lower extremity X

injury/condition.

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

4. Assesses lower extremity range of motion appropriately. X

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

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

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

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

9. Performs appropriate lower extremity neurological circulatory assessment. X

10. Documents evaluation and diagnosis appropriately. X

Therapeutic Modalities Skills

NA 5 4 3 2 1

1. Selects appropriate modality based on desired patient outcomes. X

2. Inspects modality prior to use to ensure safety. X

3. Utilizes proper patient positioning during treatments. X

4. Identifies indications and contraindications for modality use. X

5. Utilizes appropriate parameters for modality use. X

6. Utilizes correct procedures for modality application and use. X

7. Documents treatment 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

Even during observation hours last semester, Kayla was excited about athletic training, and demonstrated a working knowledge of
the scope of the athletic training. She is enthusiastic about learning new information and applying it.

Utilization of evidence-based medicine techniques in patient care

We only use evidence-based techniques at RecSports.

Strengths of the athletic training student

Kayla is punctual, focused, and always eager to learn. She has great questions that show her desire to be thorough in her
understanding of the material.

Areas for the athletic training student to improve

Kayla just needs to work on her confidence with evaluations. She sometimes hesitates, even when ultimately coming to the right
conclusions.

Do you feel students under your supervision engage in a sufficient number of real-time clinical evaluations? Why or Why Not?
I do feel like they get enough real-time situations. I often let them begin an evaluation, especially if it is lower extremity, then fill in
the blanks. As the semester continues, there is more and more they can do.

Additional comments
I feel like Kayla is exactly where she should be at this point in her first semester. She is in attendance at every single opportunity
available, despite the busy-ness of the Volleyball schedule this year. Her work ethic and positive attitude stands out.

Signature
__________________________________________ Student Signature / Date

The results of this submission may be viewed at:

https://intranet.gcsu.edu/node/1606/submission/13919
https://intranet.gcsu.edu/node/1606/submission/13919