Survey: Affective Clinical Evaluation Level I
Reviewer: Clinical Instructors (HELLEMS, Kim)
Reviewee: Students (Wingold, Shelby)
Survey Period: 3/7/2024
Completed: 4/2/2024 11:35:42 AM CT
1. First semester Evaluation:
1st Evaluation
3. Communications
Explains medical dosimetry procedures to N/A
patient as appropriate to situation (e.g.
when assisting with procedures in
treatment room or simulation).
Respects patient's rights to privacy and N/A
confidentiality.
Acts and speaks in a respectful manner Meets Expectations [10
with staff members. pts]
Asks questions in an appropriate manner. Meets Expectations [10
pts]
Accepts correction and direction in a Meets Expectations [10
professional manner. pts]
Contributes as a member of the medical Meets Expectations [10
dosimetry team. pts]
Uses effective verbal communication skills N/A
with physician during plan consultation
and review.
Uses effective written communication Meets Expectations [10
skills for chart, plan, and dosimetry note pts]
documentation.
Mean: 10.00 of 10 Points: 50 Score: 100.0%
4. Accuracy
Follows through instructions with attention Meets Expectations [10
to detail. pts]
Accurately enters information into chart or Meets Expectations [10
R & V system. pts]
Mean: 10.00 of 10 Points: 20 Score: 100.0%
5. Safety
Double checks all student work to include N/A
calculations and treatment plans with
dosimetrist/physicist.
6. Dependability
Arrives promptly as scheduled. Meets Expectations [10
pts]
Schedules breaks, lunches, and other Meets Expectations [10
time needs with clinical instructors. pts]
Adheres to attendance standards of the Meets Expectations [10
program. pts]
Uses clinical time wisely. Meets Expectations [10
pts]
Follows school and hospital policies and Meets Expectations [10
procedures. pts]
Takes initiative in observing and assisting Meets Expectations [10
in dosimetry activities. pts]
Mean: 10.00 of 10 Points: 60 Score: 100.0%
7. Application of Knowledge
Demonstrates a basic understanding of Meets Expectations [10
physics concepts and principles. pts]
Is able to retrieve imaging study (CT) and N/A
bring into patient file. Additional Comment: Does not have access to
PACS.
Is able to identify anatomy and contour Meets Expectations [10
appropriate structures. pts]
Understands the use of the computer for Meets Expectations [10
treatment planning. pts]
Is able to enter information into the N/A
computer and design a basic treatment Additional Comment: I have not evaluated any
plan in accordance with prescription. plans that she has done.
Mean: 10.00 of 10 Points: 30 Score: 100.0%
8. General Dosimetry Skills
Performs calculations in a timely manner. N/A
Accurately uses dose calculation N/A
databooks to perform hand calculations.
Is able to prioritize and organize duties to Meets Expectations [10
efficiently complete requirements. pts]
Exhibits a basic knowledge of anatomy, N/A
tissue dose tolerance, definitive tumor
dose, and typical field arrangement.
Mean: 10.00 of 10 Points: 10 Score: 100.0%
9. I have reviewed this evaluation with the student.
No
10. Additional Comments:
I have not spent a lot of time with Shelby in clinic, but the time I have spent with her tells me she
understands what she is learning, how it applies to the job, and is great at taking constructive
criticism.
Total points for all rating scale questions: 170 (Each main question equally weighted)
Mean percentage score for all rating scale questions: 100.0% Q5 not included in score due to no responses.
Response as of 4/2/2024 4:09:14 PM CT
