Student Midterm Evaluation

Please have this completed BEFORE our midterm conference. Check with your clinical instructor on specifics of time and date.
Name: 


A red asterisk (*) indicates required questions.

  1. Name:*


  1. Name of Clinical Instructor:*


  1. Clinical rotation (1st, 2nd, or 3rd):*


  1. Are you afraid to ask questions during or after treatments?*
    Yes
    No


  1. Do you feel your needs are being met by your Clinical Instructor?*
    Yes
    No


  1. Do you feel what you have learned in class has been sufficient for an ENTRY LEVEL PTA?*
    Yes
    No


  1. The CI communicated appropriate physical therapist assistant clinical goals and learning objectives for this learning experience.*
    Yes
    No


  1. The clinical education site has adequate space and equipment for student development at his/her clinical practice.*
    Yes
    No


  1. There was an adequate orientation to the clinical education program, personnel, policies, and procedures of the clinical facility.*
    Yes
    No


  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 with the CI to discuss patient/client interventions.*
    Yes
    No


  1. The CI encouraged you to evaluate your own performance.*
    Yes
    No


  1. Share a particular treatment session when you have inquired and made adjust before, during or after treatment.*


  1. Have you needed to adjust your treatment session to any patient limitations/safety concerns?*


  1. Identify some strengths of the clinical instructor:*


  1. Select, if any, what types of special learning experiences did you participate during this clinical practice?*
    Attended in-services/education programs
    Attended special clinics (wound clinic, pain clinic, etc...)
    Utilized PT Aides
    Attended Department Meetings
    Participated in Family Conferences
    Participated in any business or front desk tasks (scheduling, billing, etc..)
    None apply


  1. Do we need to meet separately during out midterm visit for any reason? If so, briefly explain below.*





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