UMaine Athletic Training Education Program
Athletic Training Student Evaluation Form

Student Information

Name_____________________________________ Course KPE 201 AT Clinical Skills - 1

Clinical Experience ___________________________________________________________

Evaluator____________________________________________Date ___________________

Purpose: To receive input from you, the Clinical Instructor, regarding the effectiveness of this athletic training student (ATS). Your comments and scoring will be shared with the ATS and the Program Director. Your insight and honesty will enhance the learning experience for this student.

Instructions:

Please evaluate this ATS by circling the number that best identifies the student at this time. If you feel that comments would be beneficial, please include those as well.

Professionalism

The student’s ability to take initiative.

1 never takes initiative

2 at times takes initiative, but still needs to be told what to do

3 takes initiative most of time

4 sees needs and completes tasks without being told

The student’s personal habits, clothing and general appearance.

1 frequently offensive

2 occasionally sloppy appearance or display of offensive habits

3 usually properly dressed and groomed; few poor personal habits

4 rarely exhibits poor appearance or offensive habits

The student’s organization abilities.

1 usually disorderly and chaotic

2 frequently unorganized

3 works sufficiently and is organized to perform job

4 highly organized and efficient worker

The student’s respect for patients, peers and supervisors.

1 frequently rude; causes discomfort to others

2 occasionally impolite to others

3 observes common courtesies

4 very conscientious of others; always polite

The student’s reliability and dependability.

1 not reliable; often fails to complete job; often absent

2 occasionally leaves routine tasks incomplete; occasionally absent

3 can be relied on to complete tasks; rarely absent

4 will complete special project; rarely absent

The student’s temperament and level of stability.

1 consistent personality; disrupts work environment

2 occasional display of temper or emotion hindering performance

3 even tempered; absorbs routine pressures of job

4 tolerate unusual pressure without hindering performance

First Aid and Emergency Care Knowledge

The student’s base knowledge of first aid and emergency care.

1 severely lacking in knowledge

2 noticeable deficiencies in knowledge base; needs intensive review

3 understands first aid and emergency situations; still some knowledge to be acquired

4 completely understands first aid and emergency situation content

The student’s willingness to show this knowledge in clinical setting.

1 has no information to share in clinical setting

2 has minimal offerings for assessment and/or management of first aid care

3 freely participates in assessment and/or management; still some areas of deficiency

4 completely competent in knowledge of first aid and emergency care

First Aid and Emergency Care Skills

The student’s ability to combine job related education, skills and experience.

1 severely lacking in knowledge

2 noticeable deficiencies

3 understands job; still some knowledge to be acquired

4 completely understands all aspects of the job

The student’s ability to communicate with patients, peers and supervisors.

1 never makes effort to keep others informed

2 rarely makes effort to keep others informed

3 usually makes effort to keep others informed

4 always keeps everyone involved informed

Please rate the student’s abilities in the following content areas using this scale:

1 unable to complete skills

2 able to complete skills with a great deal of direction and intervention by ACI

3 able to complete skills with minimal direction and intervention by ACI

4 able to complete skills proficiently

Please identify the student’s strengths including behavior qualities and working knowledge.

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Please identify areas where this student needs to improve.

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Has the student made progress and improved his/her athletic training skills and professionalism while under your supervision? In what areas?

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Has the student met your expectations and demonstrated competence as a Level 1 athletic training student?

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General Comments:

I have read this evaluation and have been given the chance to discuss the content with my supervisor.

Acceptable / Unacceptable

Revised Fall 2004