Midterm Evaluation Students

Please have this completed prior to my visit with you and your CI(s)
Name: 


A red asterisk (*) indicates required questions.

  1. Name of facility*


  1. Date of clinical affiliation *


  1. Clinical:*
    1
    2
    3


  1. The site provided a helpful and supportive attitude for me as a PTA student*
    Yes
    No


  1. The site communicated goals and learning objectives clearly*
    Yes
    No


  1. The clinical education site has adequate space to accommodate therapists, students, and patients.*
    Yes
    No


  1. There was an adequate orientation at the beginning of my clinical rotation at this site.*
    Yes
    No


  1. SAFETY: Explain how you have needed to adjust your treatment session to any patient limitations or safety concerns?*


  1. COMMUNICATION: Share how and/or when you have had to communicate with your clinical instructor, supervising PT, or other support staff regarding a patient or patient care.*


  1. INTERVENTION: Think of a patient YOU have treated yourself and reflect on how this session went.*


  1. CLINICAL PROBLEM SOLVING: Share a time you have had to consult with the clinical instructor about something that may have been complex or difficult.*


  1. Select, if any, what types of special learning experiences you participated in to this point.
    Attended in-services or educational programs
    Observed Surgery
    Used PT Aides and other support personnel
    Collaborated with other disciplines
    Participated in business management or scheduling activities.


  1. The CI provided timely feedback on student performance*
    Yes
    No


  1. The CI taught in an interactive manner that encouraged problem solving*
    Yes
    No


  1. The CI provided adequate supervision for this experience*
    Yes
    No


  1. There was adequate time to discuss patient interventions*
    Yes
    No


  1. The CI encouraged you to self evaluate*
    Yes
    No


  1. Identify strengths of your clinical instructor(s)*


  1. Any other midterm comments or concerns.





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