Student Final CI rating and feedback

Please take the time to fill this out and provide feedback on your CI and your experience.
Name: 


A red asterisk (*) indicates required questions.

  1. The clinical instructor (CI) was familiar with the academic program's objectives and expectations for this experience.*
     
      1 2 3 4 5  
    Strongly Disagree  Strongly Agree


  1. The clinical education site had written objectives for this learning experience.*
     
      1 2 3 4 5  
    Strongly Disagree  Strongly Agree


  1. The clinical education site’s objectives for this learning experience were clearly communicated.*
     
      1 2 3 4 5  
    Strongly Disagree  Strongly Agree


  1. The CI provided constructive and timely feedback on student performance.*
     
      1 2 3 4 5  
    Strongly Disagree  Strongly Agree


  1. The CI demonstrated skill in active listening.*
     
      1 2 3 4 5  
    Strongly Disagree  Strongly Agree


  1. The CI provided clear and concise communication.*
     
      1 2 3 4 5  
    Strongly Disagree  Strongly Agree


  1. The CI taught in an interactive manner that encouraged problem solving.*
     
      1 2 3 4 5  
    Strongly Disagree  Strongly Agree


  1. There was a clear understanding to whom you were directly responsible and accountable.*
     
      1 2 3 4 5  
    Strongly Disagree  Strongly Agree


  1. The supervising CI was accessible when needed.*
     
      1 2 3 4 5  
    Strongly Disagree  Strongly Agree


  1. The CI facilitated patient-therapist and therapist-student relationships.*
     
      1 2 3 4 5  
    Strongly Disagree  Strongly Agree


  1. Time was available with the CI to discuss patient/client interventions.*
     
      1 2 3 4 5  
    Strongly Disagree  Strongly Agree


  1. The CI skillfully used the clinical environment for planned and unplanned learning experiences.*
     
      1 2 3 4 5  
    Strongly Disagree  Strongly Agree


  1. The CI integrated knowledge of various learning styles into student clinical teaching.*
     
      1 2 3 4 5  
    Strongly Disagree  Strongly Agree


  1. The CI made the formal evaluation process constructive.*
     
      1 2 3 4 5  
    Strongly Disagree  Strongly Agree


  1. The CI encouraged the student to self-assess.*
     
      1 2 3 4 5  
    Strongly Disagree  Strongly Agree


  1. If there were any inconsistancies or concerns, how were they handled (if not applicable leave blank)


  1. What did your CI do well to contribute to your learning?*


  1. What, if anything, could your CI and/or other staff have done differently to contribute to your learning?*


  1. Overall, How would you rate this clinical experience?
    Excellent, I would not hesitate to have future students come here
    Great, this experience exceeded expectations
    Good, the experience met expectations
    Below average, I would recommend some things change with this site
    Poor, This clinical experience needs to be modified





Physical Therapist Assistant Program
Physical Therapist Assistant Instructor
Lake Area Technical Institute