Student Name: Clinic Name: Date:
GENERAL CLINICAL COMPETENCE / rating- Does the student demonstrate the ability to work efficiently
☐ / ☐ / ☐ / ☐ / ☐ /
- Can the student perform most clinical skills without assistance or input from the supervisor
☐ / ☐ / ☐ / ☐ / ☐ /
- Does the student demonstrate a high level of competency in their clinical skills/technique
☐ / ☐ / ☐ / ☐ / ☐ /
- Would you feel confident that the student could explain to the patient the outcome of any clinical tests they have performed
YES ☐ NO ☐
CLINCAL REASONING
- Is the student able to suggest a diagnosis from the patients presenting signs & symptoms
☐ / ☐ / ☐ / ☐ / ☐ /
- Is the student able to formulate an appropriate & targeted plan of investigation based on information obtained from history & signs
☐ / ☐ / ☐ / ☐ / ☐ /
- Is the student able to modify the way they proceed with an assessment based on the outcomes of the results of tests they have already performed?
☐ / ☐ / ☐ / ☐ / ☐ /
- Where appropriate, does the student seek further information from the patient, either during the examination or at its conclusion, thereby demonstrating the ability to actively develop an understanding of the patient’s condition and their needs as they proceed
☐ / ☐ / ☐ / ☐ / ☐ /
- Can the student clearly and articulately describe to the patient the outcome of the tests and diagnosis at a level that is appropriate for the patient and is mindful of the particular role that the orthoptist had in the clinic
☐ / ☐ / ☐ / ☐ / ☐ /
- Can the student outline a short or long term management plan for a patient/client?
☐ / ☐ / ☐ / ☐ / ☐ /
Supervisors please score the students overall level of clinical ability
Score 1 / BeginnerScore 2 / Intermediate
Score 3 / Competent
Score 4 / Proficient
Score 5
Shows NO initiative and does not participate in clinical placement
Fails to demonstrate understanding of clinical responses & application of tests / Student attempts to participate but Intervention & guidance required at all levels.
limited understanding of clinical responses / Student starts well but still requires intervention & guidance
Acceptable understanding of clinical responses & application of tests / Very minimal intervention or guidance required, student demonstrates good communication but at times can be inconsistent
Demonstrate a good level of understanding of clinical responses / Student can consistently, independently & confidently perform in all scenarios. No intervention & limited supervision is required
Demonstrates high level clinical understanding, time efficient
Student Name: Clinic Name: Date:
Learning Goals / Please take note when rating, the students opportunity to achieveAt the beginning of the student’s placement the student should have shown you their chosen learning goals for this clinical placement period. Please answer the following questions in relation to those learning goals
- Have all the stated learning goals been met to a level of competency that could be considered profession entry ready?
- Did the student have the opportunity to improve in all or only some of their learning goals (circle which best applies)
- Did the student demonstrate advancement towards achieving their learning goals
☐ / ☐ / ☐ / ☐ / ☐ /
1 = goals not achieved and/or at a poor standard
2 = intervention & guidence still required at all levels
3 = showing progress towards achieving learnng goals
4 = achieved all goals adequately
5 = student consistently performes independantly an confidently in chosen learning goals
Supervisor to Initial: Click here to enter text.
Attendance
- Student attended all allocated placements
- Any missed placements were followed up with a call to explain why not attended
- How may missed days: Click here to enter text.
YES ☐ / NO ☐
NO ☐
General Supervisor comments:
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Supervisor signature:Click here to enter text. DATE: Click here to enter text.