APTA PHYSICAL THERAPIST ASSISTANT STUDENT EVALUATION: CLINICAL EXPERIENCE AND CLINICAL INSTRUCTION
Name: 


  1. Academic Institition


  1. Name of Clinical Education Site & Address


  1. Clinical Experience Number and Dates


  1. I have reviewed information contained in this physical therapist assistant student evaluation.
    Yes
    No


  1. Primary Clinical Instructor Name


  1. Entry-level PT/PTA degree earned


  1. Highest degree earned


  1. Degree area


  1. Years experience as a CI


  1. Years experience as a clinician


  1. Areas of expertise


  1. Clinical Certification, specify area


  1. APTA Credentialed CI
    Yes
    No


  1. Other CI Credential


  1. Professional organization memberships: APTA or Other


  1. Additional Clinical Instructor Name


  1. Entry-level PT/PTA degree earned


  1. Highest degree earned


  1. Degree area


  1. Years experience as a CI


  1. Years experience as a clinician


  1. Areas of expertise


  1. Clinical Certification, specify area


  1. APTA Credentialed CI?
    Yes
    No


  1. Other CI Credential


  1. Professional organization memberships: APTA or Other


  1. Specify the number of weeks for each applicable clinical experience/rotation.
        1 2 3 4 5 6 7 8
    Acute Care/Inpatient Hospital Facility  
    Private Practice, Ambulatory Care/Outpatient  
    Rehabilitation/Sub-acute Rehabilitation  
    ECF/Nursing Home/SNF  
    School/Preschool Program  
    Federal/State/County Health  
    Wellness/Prevention/Fitness Program  
    Other  


  1. Orientation: Did you receive information from the clinical facility prior to your arrival?
    Yes
    No


  1. Orientation: Did the on-site orientation provide you with an awareness of the information and resources that you would need for the experience?
    Yes
    No


  1. What else could have been provided during the orientation?


  1. Patient/Client Management and the Practice Environment:
    During this clinical experience, describe the frequency of time spent in each of the following areas. Rate all items in using this 4 point scale: 1= Never, 2= Rarely 3= Occasionally 4= Often.

          1 2 3 4    
      Musculoskeletal   
      Neuromuscular   
      Cardiopulmonary   
      Integumentary   
      Other (,GI, GU, Renal, Metabolic, Endocrine)   
      0-12 years   
      13-21 years   
      22-65 years   
      over 65 years   
      Critical care, ICU, Acute   
      SNF/ECF/Sub-acute   
      Rehabilitation   
      Ambulatory/Outpatient   
      Home Health/Hospice   
      Wellness/Fitness/Industry   


  1. Patient/Client Management and the Practice Environment:
    During this clinical experience, describe the frequency of time spent in providing the following components of care from the patient/client management model of the Guide to Physical Therapist Practice. Rate all items in using this 4 point scale: 1= Never, 2= Rarely 3= Occasionally 4= Often.

          1 2 3 4    
      Data Collection   
      Implementation of established POC   
      Coordination, communication, documentation   
      Patient/client related instruction   
      Direct Interventions   


  1. List the 5 most common interventions that you provided to patients/clients during this clinical experience.


  1. Patient/Client Management and the Practice Environment:
    During this clinical experience, how frequently did staff maintain an environment conducive to your work and growth? Rate all items in using this 4 point scale: 1= Never, 2= Rarely 3= Occasionally 4= Often.

          1 2 3 4    
      Providing a helpful and supportive attitude for your role as a PTA student.   
      Providing effective role models for problem solving, communication, and teamwork.   
      Demonstrating high morale and harmonious working relationships.   
      Adhereing to ethical codes and legal statutes and standards (Medicare, HIPAA, informed consent, APTA Code of Ethics, etc)   
      Being sensitive to individual differences (race, age, ethinicity, etc)   
      Using evidence to support clinical practice.   
      Being involved in professional development (degree and non-degree continuing education, in-services, journal clubs, etc)   
      Being involved in district, state, regional, and/or national professional activities.   


  1. What suggestions, relative to the above questions items could you offer to improve the environment for your work and growth?


  1. Were there other students at this clinical facility during your clinical experience? Check all that apply:
    PT students
    PTA students
    Students from other disciplines (specify below)


  1. Students from other disciplines, specify


  1. Identify the ratio of students to CIs for your clinical experience:
    1 student to 1 CI
    1 student to > than 1 CI
    1 CI to greater than 1 student; (describe below)


  1. 1 CI to greater than 1 student, describe


  1. How did the clinical supervision ration influence your learning experience?


  1. In addition to patient/client management, what other learning experiences did you participate in during this clinical experience? Check all that apply
    Attended in-services/educational programs
    Presented an in-service
    Attended special clinics
    Attended team meetings/conferences/grand rounds
    Observed surgery
    Participated in administrative and business management
    Participated in providing patient/client interventions collaboratively with other disciplines
    Participated in service learning
    Performed systematic data collection as part of an investigative study
    Used physical therapy aides and other support personnel
    Other (specify below)


  1. Other, please specify


  1. Please provide any logistical suggestions for this lcoation that may be helpful to students in the future. Include costs, names of resources, housing food, parking, etc


  1. Overall, how would you assess this clinical experience? (Check only one)
    Excellent clinical learning experience; would not hesitate to recommend this clinical education site to another student.
    Time well spent; would recommend this clinical education site to another studetn.
    Some good learning experiences; student program needs further development.
    Student clinical education program is not adequately developed at this time.


  1. What specific qualities or skills do you believe a physical therapist assistant student should ahve to function successfully at this clinical education site?


  1. If during this clinical education experience, you were exposed to content not include in your previous physical therapist assistant academic preparation describe those subject areas not addressed.


  1. What suggestions would you offer to futre physical therapist assistant students to improve this clincal education experience?


  1. What do you believe were the strengths of your physical therapist assistant academic preparation and/or coursework for this clinical experience?


  1. What curricular suggestions do you have that would have prepared you better for this clinical experience?


  1. MIDTERM: Use the scale below, rate how clinical instruction was provided during this clinical experience at both midterm and final evaluations (shaded columns).
    1= Strongly Disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree

          1 2 3 4 5    
      The CI was familiar with the academic program's objectives and expectations for this experience.   
      The clinical education site had written objectives for this learning   
      The clinical education site's objectives for this learning experience were clearly communicated.   
      There was an opportunity for student input into the objectives for this learning experience.   
      The CI provided constructive feedback on student performance.   
      The CI provided timely feedback on student performance.   
      The CI demonstrated skill in active listening.   
      The CI provided clear and concise communication.   
      The CI communicated in an open and non-threatening manner.   
      The CI taught in an interactive manner that encouraged problem solving.   
      There was a clear understanding to whom you were directly responsible and accountable.   
      The supervising CI was accessible when needed.   
      The CI clearly explained your student responsibilities.   
      The CI provided responsibilities that were within your scope of knowledge and skills.   
      The CI facilitated patient-therapist and therapist-student relationships.   
      Time was available with the CI to discuss patient/client interventions.   
      The CI served as a positive role model in physical therapy practice.   
      The CI skillfully used the clinical environment for planned and unplanned learning experiences.   
      The CI integrated knowledge of various learning styles into student clinical teaching.   
      The CI made the formal evaluation process constructive.   
      The CI encouraged the student to self-assess.   


  1. MIDTERM: Was your CI's evaluation of your level of performance in agreement with your self-assessment?
    Yes
    No


  1. MIDTERM: If there were inconsistencies, how were they discussed and managed?


  1. MIDTERM: What did your CI(s) do well to contribute to your learning?


  1. MIDTERM: What, if anything, could your CI(s) and/or other staff have done differently to contribute to your learning?


  1. FINAL: Use the scale below, rate how clinical instruction was provided during this clinical experience at both midterm and final evaluations (shaded columns).
    1= Strongly Disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree

          1 2 3 4 5    
      The CI was familiar with the academic program's objectives for this experience.   
      The clinical education site had written objectives for this learning   
      The clinical education site's objectives for this learning experience were clearly communicated.   
      There was an opportunity for student input into the objectives for this learning experience.   
      The CI provided constructive feedback on student performance (strengths & weaknesses).   
      The CI provided timely feedback on student performance.   
      The CI demonstrated skill in active listening.   
      The CI provided clear and concise communication.   
      The CI communicated in an open and non-threatening manner.   
      The CI taught in an interactive manner that encouraged problem solving/critical thinking.   
      There was a clear understanding to whom you were directly responsible and accountable.   
      The supervising CI was accessible and provides assistance when needed.   
      The CI clearly explained your student responsibilities and expectations.   
      The CI provided responsibilities that were within your scope of knowledge and skills.   
      The CI facilitated patient-therapist and therapist-student relationships.   
      Time was available with the CI to discuss patient/client interventions.   
      The CI served as a positive role model in physical therapy practice while adhering to the APTA Code of Ethics.   
      The CI skillfully used the clinical environment for planned and unplanned learning experiences.   
      The CI integrated knowledge of various learning styles into student clinical teaching.   
      The CI made the formal evalauation process constructive and documented areas for improvement.   
      The CI encouraged the student to self-assess.   
      CI acts as a liason between the clinical site, Carrington College and students   
      CI expects professional accountability.   
      CI models professional behavior with patients.   
      CI models professional behavior with clinical staff/healthcare providers.   
      CI encouraged initiative.   
      CI was knowledgeable in PT interventions   
      CI was prepared and organized in the clinic.   
      Encourages critical thinking   
      Encourages initiative   
      Provides assistance when needed   
      Knowledgeable in PT interventions   
      Is prepared and organized in clinic   
      Communicates expectations   
      Identifies strengths and weaknesses of students   
      Documents areas for student improvement   
      Expects professional accountability   
      Acts as a liaison between clinical site, Carrington College and students   
      Adheres to the APTA Code of Ethics   
      Models professional behavior with patients   
      Models professional behavior with clinical staff/ healthcare providers   
      I felt I treated a diverse patient/client population   
      The equipment at the facility was current and in good working condition   
      I utilized and was able to practice Physical Therapy interventions under the guidance of the supervising Physical Therapist   
      Personal safety precautions were emphasized as well as during patient interventions   


  1. FINAL: Was your CI's evaluation of your level of performance in agreement with your self-assessment?
    Yes
    No


  1. FINAL: If there were inconsistencies, how were they discussed and managed?


  1. FINAL: What did your CI(s) do well to contribute to your learning?


  1. FINAL: What, if anything, could your CI(s) and/or other staff have done differently to contribute to your learning?


  1. I felt I treated a diverse patient/client population.
    Please evaluate your clinical site using the following scale:
    5 = completely agree 4 = strongly agree 3 = agree most of the time 2 = disagree 1 = strongly disagree

    1 2 3 4 5


  1. The equipment at the facility was current and in good working condition.
    Please evaluate your clinical site using the following scale:
    5 = completely agree 4 = strongly agree 3 = agree most of the time 2 = disagree 1 = strongly disagree
    1 2 3 4 5


  1. I utilized and was able to practice Physical Therapy interventions under the guidance of the supervising Physical Therapist.
    Please evaluate your clinical site using the following scale:
    5 = completely agree 4 = strongly agree 3 = agree most of the time 2 = disagree 1 = strongly disagree
    1 2 3 4 5


  1. Personal safety precautions were emphasized as well as during patient interventions.
    Please evaluate your clinical site using the following scale:
    5 = completely agree 4 = strongly agree 3 = agree most of the time 2 = disagree 1 = strongly disagree
    1 2 3 4 5





Dr. Mills
PTA Program Director
Carrington College Las Vegas
Las Vegas, NV