UMaine Athletic Training Education Program
Athletic Training Student Evaluation Form
Name_____________________________________ Course KPE 201 AT Clinical Skills - 1
Clinical Experience ___________________________________________________________
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.
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.
The studentís 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 studentís 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 studentís 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 studentís 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 studentís 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 studentís 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 studentís 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 studentís 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 studentís 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 studentís 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 studentís 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
|Basic Life Support|
|Basic Injury Assessment|
|Emergency Care Management|
|Managing Environmental Injuries|
Please identify the studentís strengths including behavior qualities and working knowledge.
Please identify areas where this student needs to improve.
Has the student made progress and improved his/her athletic training skills and professionalism while under your supervision? In what areas?
Has the student met your expectations and demonstrated competence as a Level 1 athletic training student?
I have read this evaluation and have been given the chance to discuss the content with my supervisor.
|Program Directorís Signature||Date|
Acceptable / Unacceptable
Revised Fall 2004