Sample Preceptor Evaluation of Student
Evaluation Key:
- Level I: Rarely requires assistance (meets this clinical competency most of the time independently)
- Level II: Requires some assistance (meets this clinical competency half of the time independently)
- Level III: Requires substantial assistance (rarely meets this clinical competency independently)
- N/O: No opportunity to observe this clinical competency
Final clinical grade is either Pass or No Pass.
A Level III on any clinical competency will result in a second site visit by the faculty.
A Level III on any clinical competency on the final evaluation will result in a grade of No Pass.
In order that course faculty may assist students who are having difficulty in clinical, preceptors should notify course faculty immediately when they evaluate a student at a Level III on one or more clinical competency.
All responses are required
Part I: Patient Centered Care
1. Elicits patient values, preferences, and expressed needs as part of the clinical interview, diagnosis, implementation of care plan, and evaluation of care.
Select one:
- Level I
- Level II
- Level III
- N/O
2. Elicits relevant history (episodic, follow-up or comprehensive) demonstrating sensitivity, empathy, and respect for diverse groups of patients by including patient values and preferences.
Select one:
- Level I
- Level II
- Level III
- N/O
3. Performs appropriate/relevant physical examination (age-appropriate, comprehensive, or focused).
Select one:
- Level I
- Level II
- Level III
- N/O
4. Assesses and manages pain and suffering based on patient's values, preferences, and expressed needs.
Select one:
- Level I
- Level II
- Level III
- N/O
5. Demonstrates knowledge of pathophysiology of patient conditions for differential diagnosis and associated pharmacological interventions, drawing on past experiences to improve quality of life for individuals, families, and community systems in a comprehensive therapeutic plan of care.
Select one:
- Level I
- Level II
- Level III
- N/O
6. Demonstrates cultural humility and respect for diversity when evaluating health promotion/self-care activities of patient/family and in promoting health maintenance/health promotion plan.
Select one:
- Level I
- Level II
- Level III
- N/O
7. Advocates for and includes the patient and family as the center of the caregiving team when setting and modifying care goals.
Select one:
- Level I
- Level II
- Level III
- N/O
8. Demonstrates appropriate teaching/counseling skills re: patient/family identified health problems, risk factors, and preventative care.
Select one:
- Level I
- Level II
- Level III
- N/O
Part II: Teamwork & Collaboration
9. Functions competently to the fullest scope of the advanced practice role as a member of the health care team.
Select one:
- Level I
- Level II
- Level III
- N/O
10. Consults and solicits guidance with diagnostic reasoning from appropriate individuals/sources.
Select one:
- Level I
- Level II
- Level III
- N/O
11. Uses appropriate communication with patients, families, and healthcare team members by analyzing and improving own communication skills.
Select one:
- Level I
- Level II
- Level III
- N/O
12. Engages patient and family in a collaborative relationship by asking for and respecting their input, and providing relevant information, resources, access, and support with attention to health care literacy.
Select one:
- Level I
- Level II
- Level III
- N/O
13. Collaborates with others (i.e. specialists, pharmacists, social workers) to empower patient/family to achieve goals.
Select one:
- Level I
- Level II
- Level III
- N/O
Part III: Evidence Based Practice
14. Employs efficient and effective search strategies to answer focused clinical questions.
Select one:
- Level I
- Level II
- Level III
- N/O
15. Exhibits comprehensive knowledge of best evidence related to practice specialty and incorporates one's own clinical expertise when developing list of appropriate differential diagnoses.
Select one:
- Level I
- Level II
- Level III
- N/O
16. Discusses/performs appropriate evidence-based diagnostic work-up.
Select one:
- Level I
- Level II
- Level III
- N/O
17. Analyzes how the strength of available evidence impacts policy changes and influences the provision of care (assessment, diagnosis, treatment, and evaluation).
Select one:
- Level I
- Level II
- Level III
- N/O
Part IV: Quality Improvement
18. Demonstrates awareness of cost-effectiveness of diagnostic work-up and management options.
Select one:
- Level I
- Level II
- Level III
- N/O
19. Uses data to review processes and outcomes of care and identify potential areas for improvement.
Select one:
- Level I
- Level II
- Level III
- N/O
20. Uses systematic, data driven approaches (i.e. PDSA cycles) to change processes of care.
Select one:
- Level I
- Level II
- Level III
- N/O
Part V: Safety
21. Participates as a team member to design, promote, and model effective use of technology and standardized practices that support safety and quality.
Select one:
- Level I
- Level II
- Level III
- N/O
22. Employs effective strategies to reduce reliance on memory (i.e. checklists, forcing functions) and improve organization/time management.
Select one:
- Level I
- Level II
- Level III
- N/O
23. Supports a Just Culture and systems focus by communicating concerns related to hazards and errors without engaging in blame behaviors.
Select one:
- Level I
- Level II
- Level III
- N/O
24. Identifies and corrects system failures and hazards in care.
Select one:
- Level I
- Level II
- Level III
- N/O
25. Prevents escalation of conflict by responding appropriately to aggressive behavior.
Select one:
- Level I
- Level II
- Level III
- N/O
Part VI: Informatics
26. Documents data in an organized and comprehensive manner utilizing appropriate technology safety and security.
Select one:
- Level I
- Level II
- Level III
- N/O
27. Champions communication technologies that support tracking and interpretation of outcomes, clinical decision-making, error prevention, care coordination, and protection of patient privacy.
Select one:
- Level I
- Level II
- Level III
- N/O
Part VII: Professional Role Development
28. Manages time with increasing competency - Conducts patient visits and other on-site activities within expected timeframe.
Select one:
- Level I
- Level II
- Level III
- N/O
29. Presents self in accordance with clinical agency, School of Nursing, and professional standards for appearance and conduct.
Select one:
- Level I
- Level II
- Level III
- N/O
30. Demonstrates personal responsibility and accountability for accurate history and assessment, plan of care, treatment outcomes, and follow-up.
Select one:
- Level I
- Level II
- Level III
- N/O
31. Assumes full accountability for professional behavior and performs within accepted ethical and legal standards.
Select one:
- Level I
- Level II
- Level III
- N/O
32. Accepts constructive feedback, self reflects, and develops an action plan for improvement.
Select one:
- Level I
- Level II
- Level III
- N/O
33. Engages in reflective practice to critique, develop, and monitor own learning needs; seeks/negotiates clinical experiences to meet those needs.
Select one:
- Level I
- Level II
- Level III
- N/O
34. Is prepared for clinical experience.
Select one:
- Level I
- Level II
- Level III
- N/O
