D2.Student Review Level I FW: Eval & Intervention

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 3 2 1
I demonstrated a respect for time (arriving on time, began/ended treatment on time, used time wisely, etc.) * 4 3 2 1
My behaviors indicated an interest in learning (e.g. asked for help/feedback appropriately, asked appropriate questions, sought extra learning opportunities, etc.) * 4 3 2 1
I demonstrated carryover, adjusting my performance based on feedback. * 4 3 2 1
I attended all scheduled clinical days. * Yes No
I interacted with clients and staff appropriately and professionally. * 4 3 2 1
I asked appropriate questions that showed incorporation of prior knowledge and/or to show higher level of assimilation of learned materials. * 4 3 2 1
I adhered to all safety regulations in the practice setting. * 4 3 2 1
I adhered to ethics and confidentiality (HIPAA) during interactions with clients, families, and other professionals. * 4 3 2 1
I documented findings of an assessment and/or evaluation appropriately for the setting. * 4 3 2 1
I demonstrated the abilities to interpret and report assessment results using appropriate professional written and verbal language. * 4 3 2 1
I developed an intervention plan based upon evaluation findings, appropriate theoretical perspectives, and client needs. * 4 3 2 1
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 3 2 1
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 3 2 1
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 3 2 1
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 FW E & I, what would be your advice to them? *
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: Eval & Intervention

D2.Student Review Level I FW: Eval & Intervention

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