CI ASSESSMENT OF STUDENT PERFORMANCE

1. Mark the student as they have demonstrated thus far in the rotation. This evaluation should be based off more than one circumstance or exposure and should reflect their overall, consistent performance in the skill.

• For example, it’s unfair to grade a student at “0” for vitals if they’ve only had 1 opportunity to take vitals. Provide them with additional opportunities to better assess.

2. Please be aware that each rotation has a different expected level of performance or min benchmark, which is noted in the syllabus.

• For example, the program cannot expect the student to be marked at “entry level” for all criteria during a clinical I experience.

3. Please remember that every skill that you do in your clinic, may not be “entry level”.

• For example, specific manual therapy mobilization techniques of the spine learned at a CEU course, is not an entry level skill.

4. If you have not observed the student perform a criterion, please attempt to role play scenarios in the clinic prior to finalizing the evaluation.

• If you simply do not have the resources or equipment for the skill to be practiced, then please check the N/A column.

5. The highlighted area/questions are considered serious concerns and must be passed at a 3 as these are of significant concern if they are not achieved.

6. Please provide comments for any scores marked below a 3. If no comment please enter N/A. 

7. If you anticipate the student will score a “0” Flag/significant concern- please alert the ACCE as soon as possible so they can assist the student with remediation of that criteria.

8. Entry level definition:

• Entry-level is defined as the expectations of a new graduate, new hire and typically involves continued need for mentoring and guidance.

9. FOR CLINICAL III (PTA234) STUDENTS ONLY:

• The program cannot confidently graduate students who do not rate at entry level in all criteria by the end of the rotation. Please talk to the CCCE and ACCE (as soon as possible) if you feel there are certain criteria for which the student does not meet entry level.

Student's Full Name

CI Full Name

Secondary CI Full Name, if applicable:

Clinical Rotation

Class of

Evaluation

Caseload

What is the expected daily caseload for an entry level PTA per day at the current facility?

On average, how many patients do you feel the student is CAPABLE of seeing per day?

Please rate each skill below based on performance. If the rating is below a 3, please provide a comment. If no comment, please enter N/A. To submit the form, either a comment or N/A must be entered. 

1. Safety: ensures safety with all clinical interactions and application of interventions.

1a. Comments Safety

2. Ethical and Legal Practice: abides by ethical and legal
practice, including state practice act.

2a. Comments Ethical and Legal Practice:

3. Ethical and Legal Practice: adheres to HIPAA (patient
confidentiality).

3a. Comments Ethical and Legal Practice HIPAA:

4. Communication: conducts self professionally in general interactions with members of the healthcare team, patients and caregivers (verbal and non-verbal). PT/PTA relationships.

4a. Comments Communication:

5. Communication: Cultural competence- treats all patients with respect and dignity regardless of age, race/ethnicity, background, disability, etc.

5a. Comments Communication Cultural:

6. Communication: ability to resolve conflict- may include flexibility in scheduling to handling disagreements or confrontation.

6a. Comments Communication resolve conflict:

7. Professionalism: demonstrates punctuality and dependability.

7a. Comments Professionalism Punctuality:

8. Professionalism: demonstrates initiative.

8a. Comments Professionalism Initiative:

9. Professionalism: exhibits compassion and caring.

9a. Comments Professionalism Compassion:

10.Professionalism: maintains professional appearance (dress, posture, etc.) appropriate for clinical setting.

10a. Comments Professionalism Appearance:

11. Professionalism: received feedback in a constructive manner.

11a. Comments Professionalism Feedback:

12.Time Management: utilization of time to be productive.

12a. Comments Time Management:

13.Equipment management: able to utilize, adjust equipment appropriately for patient needs.

13a. Comments Equipment Management:

14.Environmental management: able to navigate various areas/departments of the facility and prevent environmental hazards

14a. Comments Environmental Management:

15.Disease and Disability Awareness: recognizes red flags and researches unknown topics/dx.

15a. Comments Disease and Disability:

16. Chart review: able to generally under stand POC and goals.

16a. Comments Chart Review:

17. Monitoring and Progression: capable of monitoring patient to determine proper course for treatment session.

17a. Comments Monitoring and Progression:

18. Documentation: ability to document appropriately in each section and within a timely fashion.

18a. Comments Documentation:

19. Billing: follows legal billing standards for one on one treatments.

19a. Comments Billing:

20. Gait Training; able to properly demonstrate, instruct, guard, and provide feedback to a patient ambulating with an assistive device.

20a. Comments Gait Training:

21. Gait Analysis and Training: able to recognize abnormal aspects of gait and properly demonstrate, instruct, guard, and provide feedback to a patient ambulating without an assistive device.

21a. Comments Gait Analysis Training:

22. Wheelchair mobility: Being able to navigate manual and power wheelchairs and perform minor modifications or repairs.

22a. Comments Wheelchair mobility:

23. Exercise Development and Instruction: demonstrates understanding of basic exercise purpose, creation and instruction to patient.

23a. Comments Exercise Development:

24. Patient Positioning: provides cueing to correct patient’s positioning/ posture/ technique throughout treatment.

24a. Comments Patient Positioning:

25. Vital Signs: able to obtain vital information correctly and within a timely fashion (BP, SpO2, RR, HR, etc.)

25a. Comments Vital Signs:

26. Transfers: able to perform safe transfers (by providing appropriate assistance levels) and utilize equipment as needed.

26a. Comments Transfers:

27. Goniometry: performs ROM measurements for UE, trunk and LE correctly and in a timely fashion.

27a. Comments Goniometry:

28. MMT: performs strength testing for UE, trunk, and LE correctly and in a timely fashion.

28a. Comments MMT:

29. Modalities: able to utilize electrotherapeutic modalities (IFC,NMES, FES, etc.) correctly.

29a. Comments Modalities:

30. Modalities: able to utilize thermal modalities (US, MH, CP, paraffin, fluido-therapy, etc.)correctly.

30a. Comments Thermal Modalities:

31. Modalities; able to utilize non-thermal modalities (Blood flow restriction, traction and compression) correctly.

31a. Comments Non-Thermal Modalities:

32. Manual techniques: able to apply basic manual techniques (Therapeutic massage, Soft tissue mobilization, PROM)
Please provide feedback about joint mobilizations on the following tab under Qualitative Feedback

32a. Comments Manual Techniques: 

33. Functional Testing; able to understand, correctly perform and document functional testing for balance, falls, strength, etc.

33a. Comments Functional Testing:

34. Sensory Testing: able to demonstrate proper technique with sensory tests and general understanding of dermatomes.

34a. Comments Sensory Testing:

35. Body Mechanics: able to demonstrate appropriate body mechanics for their body.

35a. Comments Body Mechanics:

36. PT Education: able to provide basic and timely pt. education clearly and concisely.

36a. Comments PT Education:

37. Critical thinking: student is able to critically think and problem solve through appropriate rationale.

37a. Comments Critical Thinking:

Qualitative Feedback

Joint mobilizations: Since the APTA’s document titled Minimum Required Skills of Physical Therapist Assistant Graduates at Entry-Level, does not consider joint mobilizations an entry level skill, please add feedback on joint mobilizations here.

Comments Joint Mobilization

Comments: Other interventions not listed previously in the assessment: 

Please rate the other intervention you listed above: 

Comments: Other interventions not listed previously in the assessment: 

Please rate the other intervention you listed above: 

Exposure and level of competence with specialty services (such as hydrotherapy, vestibular, advanced manual techniques, wound care, etc.):

Additional Comments:

Sign and Submit: If no secondary CI, please write N/A and select date of submission.

Clinical Instructor Signature:

I have reviewed and discussed this assessment with the student. The original will be submitted to the ACCE and a copy will be kept at the clinical site.

Date of Clinical Instructor Signature:

Secondary Clinical Instructor Signature:

I have reviewed and discussed this assessment with the student. The original will be submitted to the ACCE and a copy will be kept at the clinical site.

Date of Secondary Clinical Instructor Signature: