D2.Student Review Level I FW: E&I (for 2023)

Self Evaluation of professional and learning behaviors during Level I Fieldwork Evaluation and Intervention.

Student Name * First Last
Student Email
Today's Date * / MM / DD YYYY
Facility Name *
Primary Fieldwork Setting *
If Other, please describe the primary fieldwork setting *
List the assessments you used to meet the course objectives at this facility. *
4 — Exemplary Performance: Demonstrates satisfactory competence in specific skills consistently; demonstrates substantial breadth and depth in understanding and/or skillful application of fundamental knowledge and skills.

3 — Proficient Performance: Demonstrates satisfactory competence in specific skills; demonstrates adequate understanding and/or application of fundamental knowledge and skills. This rating should be used most frequently.

2 — Emerging Performance: Demonstrates limited competence in specific skills (inconsistencies may be evident); demonstrates limited understanding and/or application of fundamental knowledge and skills (displays some gaps and/or inaccuracies). This is an acceptable rating for clinical skills/abilities for this fieldwork experience.

1 — Unsatisfactory Performance: Fails to demonstrate competence in specific skills; performs in an inappropriate manner; demonstrates inadequate understanding and/or application of fundamental knowledge and skills; (demonstrates significant gaps and/or inaccuracies).
I exhibited a professional image. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
I demonstrated a respect for time (arriving on time, began/ended treatment on time, used time wisely, etc.) * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
My behaviors indicated an interest in learning (e.g. asked for help/feedback appropriately, asked appropriate questions, sought extra learning opportunities, etc.) * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
I demonstrated carryover, adjusting my performance based on feedback. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
I attended all scheduled clinical days. * Yes No
I interacted with clients and staff appropriately and professionally. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
I asked appropriate questions that showed incorporation of prior knowledge and/or to show higher level of assimilation of learned materials. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
I adhered to all safety regulations in the practice setting. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
I adhered to ethics and confidentiality (HIPAA) during interactions with clients, families, and other professionals. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
I documented findings of an assessment and/or evaluation appropriately for the setting. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
I demonstrated the abilities to interpret and report assessment results using appropriate professional written and verbal language. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
I developed an intervention plan based upon evaluation findings, appropriate theoretical perspectives, and client needs. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
As a student, I sought and received feedback on my evaluation report and intervention plan. *
Intervention Critique: How did you (or can you) grade a piece of the intervention plan up or down to meet the needs of the client. A minimum of 2 modifications must be discussed. *
Intervention Critique: Provide your personal reflection on how you performed during the evaluation session and when writing the evaluation/intervention report (must include strengths and areas for improvement). Consider the fieldwork educator's teaching and learning style and if it was effective or not with your learning style (consider what could have been done differently or how you adapted as a student). *
I selected and utilized appropriate occupation-based and preparatory methods (if needed) for client-centered interventions within the constraints of the practice environment. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
I monitored and reassessed, in collaboration with the client, caregiver, family, and significant others, the effect of occupational therapy intervention and the need for continued or modified intervention. * 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
I demonstrated an understanding of health literacy and the ability to educate and train the client, caregiver, family, and significant others, and communities to facilitate skills in the areas of occupation as well as prevention, health maintenance, health promotion, and safety.
* 4 - Exemplary Performance 3 - Proficient Performance 2 - Emerging Performance 1 - Unsatisfactory Performance
Check all that apply regarding application of the Review of Clinical Knowledge (ROCK) components: I completed the following components of the ROCK (this can include client practice, discussion or education with fieldwork educator): * Range of Motion Manual Muscle Testing Transfers
If you did not select a ROCK component in the previous question (did not complete a component), please indicate your rationale here. Additionally, if you have any information for the course instructor regarding your performance on these components, please do so in this space.
What was the primary model of supervision used (check the most frequently used model)? * one fieldwork educator: one student one fieldwork educator: group of students two fieldwork educators: one student one fieldwork educator: two students distant supervision (primarily off-site) three or more fieldwork educators: one student (count person as fieldwork educator if supervision occured at least weekly)
Supervisory methods to promote reflective practice (check all that apply):
* Processing verbally Student self-assessment Written submission of learning assignments (e.g. intervention plans, evaluations, rationale, facility-assigned tasks, etc.) Other
Fieldwork educator(s) provided a positive role model of professional behavior in practice:
* Strongly Agree Agree Neutral Disagree Strongly Disagree
Fieldwork educator(s) modeled and/or encouraged occupation-based and client-centered practice: * Strongly Agree Agree Neutral Disagree Strongly Disagree
General comments on supervision (optional):
What was the most important thing you learned from this fieldwork experience? *
What was the second most important thing you learned from this fieldwork experience? *
What did you like least about this experience? *
What suggestions do you have to improve this Level I Fieldwork experience. *
If another student is assigned to the same facility next semester for Level I Fieldwork E&I, what would be your advice to them? *
Health Literacy Written Reflection:
Challenge Activity:
What did you learn from the plain language challenge activity?
*
Written Handout Activity:
What did you learn from the written activity? *
Written Handout Activity:
What specific section of the information did you have most trouble simplifying? Why? *
Written Handout Activity:
What are the key aspects of reducing the grade level to the 5th grade? How did you accomplish this task? *
Overall Assignment (both parts)
After discussing plain language with your educator and writing a simplified handout for your Whatchamacallit, reflect on how this assignment will impact how your practice? (Please address both parts of this reflection). *
I acknowledge that the person completing this evaluation is the student listed above. Furthermore, I have reviewed this evaluation with the fieldwork educator (site).
Yes No
*NOTE: You may print this evaluation after clicking on "CONTINUE" and before choosing "SUBMIT".

D2.Student Review Level I FW: E&I (for 2023)

D2.Student Review Level I FW: E&I (for 2023)

Health Literacy Written Reflection:

*NOTE: You may print this evaluation after clicking on "CONTINUE" and before choosing "SUBMIT".