UNIVERSITY OF CONNECTICUT

DEPARTMENT OF COMMUNICATION SCIENCES

SUMMARY OF CLINICAL PERFORMANCE

SPEECH-LANGUAGE PATHOLOGY

Student: / Date of Summary:
Advisor: / Period Covered:
Site of Practicum: / Clinical Term: / I / II / III / IV / V
Supervisor: / Clock Hours Earned:
Assignment: (management, assessment, child, adult, disorder category, individual group)

This “Summary of Clinical Performance” shows a rating for those categories and tasks that were part of the student’s assignment in this term with this supervisor. The Summary is based on the “Checklist of Clinical Skills” (rev. 7/03), which provides information about the expected level of achievement for each task at this point in the student’s preparation.

Key for Ratings:X = not applicable

ED = exceeded expected level with distinction

E = exceeded expected level

M = met expected level

NM/E = did not meet expected level, but emerging

NM = did not meet expected level

SUMMARY OF CLINICAL COMPETENCIES

I. Assessment /
  1. Prepares thoroughly for evaluations by familiarizing self with available information and selecting appropriate test instruments and procedures. (Section I. A. 1-7)

  1. Conducts interview skillfully. (B. 1-3)

  1. Demonstrates proficiency with test administration procedures, equipment, and materials. (B.4-9)

  1. Records, scores, and analyzes data accurately. (B. 10-11; C. 1-3)

  1. Synthesizes and interprets information accurately to devise appropriate recommendations. (C. 4)

  1. Conveys findings and recommendations to client/family/others clearly. (C. 4-5)

  1. Recognizes opportunities and counsels client/family/others regarding communication disorders. (D. 1-2)

Remarks
II. Intervention /
  1. Develops long term/treatment plans that are relevant. (Section II. A. 1-3)

  1. Develops short term/lesson plans that are comprehensive and thorough. (A. 1-3)

  1. Implements plans efficiently and effectively to achieve expected outcome for client. (B. 1-2)

  1. Counsels client/family/others regarding prevention of communication disorders. (B.3; C.1)

  1. Accurately appraises appropriateness, adequacy, and relevance of client outcome. (B.2, C. 1-8)

Remarks
III. Records and
Reports /
  1. Writes reports with accurate spelling, punctuation, and professional terminology. (Section III. A. 1-8)

  1. Writes reports that are clear, concise, and accurate. (B. all)

  1. Completes all forms related to client/patient care and to the work setting thoroughly and accurately. (C. 1-4)

Remarks
IV. Supervisory
Process /
  1. Identifies and monitors expected outcomes of supervisor/supervisee interaction independently. (Section IV. 1-3)

  1. Self-evaluates progress toward outcomes of supervision consistently and accurately. (4)

  1. Participates actively and appropriately in supervisory conferences. (5-7)

Remarks
V. Technology,
Equipment,
and Materials /
  1. Follows risk management procedures consistently. (Section V. A. 1)

  1. Uses equipment and material effectively to accomplish expected outcomes of assessment and/or intervention. (B. 1-3)

  1. Shows proficiency in using equipment and materials. (B. 4-5)

Remarks
VI. Professionalism and Interpersonal /
  1. Sets high standards for the quality of services provided. (Section VI. A. 1, 4, 10-14)

  1. Functions in a manner consistent with the practices and procedures of the work setting. (A. 2, 3, 5, 6, 8, 9)

  1. Upholds ASHA’s Code of Ethics. (A. 7)

  1. Demonstrates appropriate interpersonal skills. (B. 1-15)

Remarks

______

Graduate Student ClinicianClinical Supervisor

Reviewed on: ______Recommended grade for this clinical assignment: _____

Percentage of time supervised: ______

UCSHC SI19

Revised 4/08