Multi Rater Competency Assessment

2015 - 2016 - NURS 253 Practical Nursing Pre-graduate Experience MRA Final (201508)
NURS 253 Practical Nursing Pregraduate experience (PN, 18-Jan-2016 - 07-May-2016)
Student :
Clinical Teacher/Preceptor :
Advisor :
Program Coordinator :
Location :
Placement Setting :
Unit/Office/Clinic :
Period :
Student hours :
Required Hours :
Validated hours :

Natasha English
Gifty Oppong
Zabrina Chevannes
Judy Martin
William Osler Health Centre/Brampton Civic Hospital
Agency
N3
18-Jan-2016 To 07-May-2016
448
448
448

I declare that this is my original work and the sources used are acknowledged.

Abilities and Outcomes / Learning Outcomes

Student Rating

Teacher Rating

1. Model safe, competent, and ethical practice in compliance with legal and regulatory frameworks and the policies and procedures of the
practice setting.

1. 1 Comply with regulatory standards, relevant legislation and the practice settings policies and

Satisfactory

Satisfactory

Satisfactory

Satisfactory

procedures.
N.E. : I followed all standards, policies and procedures throughout my pre-graduate experience.

1. 2 Act in a professional, responsible, ethical and accountable manner.

N.E. : There was a situation where the mother of a patient had a migraine and asked for us to provide her with Tylenol or Advil. I had to educate her
on the policies and rationale as to why this was not something I could do. I advised her that we could only give medication for which their was an order
and it had to be for an admitted patient. She also asked for us to call the Dr to get an order and I had to tell her that because she was not a patient, we
were unable to call. I did provide her with an alternative of going down to the ER, or going next door to the store for pain relief. I could have given her
some tylenol without anyone noticing, however I acted ethically, professionally, and responsibly by following the policies of the hospital.

1. 3 Use the three factor and decision making frameworks to determine strengths and limitations and

Satisfactory

Satisfactory

when to collaborate and consult with other professionals.

N.E. : I consider the 3 factor framework whenever I work with a patient. Since I'm a student nurse, I know that there are many things which I can
handle but also many things which I need to consult and collaborate on as I am still developing my knowledge skills and judgement.

1. 4 Integrate evidence-informed practice and a theory based approach into nursing care.

Satisfactory

Satisfactory

N.E. : I believe I have satisfied this requirement. For example, I had a patient who was to get a PRN 3% saline inhalation. However the mother
advised she had just fed several oz's, and since I know that these inhalations can induce coughing, I decided to hold off on the inhalation and he also
had been having episodes of emesis.

G.O. : This was a good example of using clinical judgement which Natasha is good at, she always collaborated with me and asked appropriate
questions. The inhalation was given later with good effect without patient vomitting.

1. 5 Assess practices and risk management principles and take action to ensure safety of clients,

Satisfactory

Satisfactory

self, and others.

N.E. : I consistently assess my practices and principles to ensure safety of everyone. For example, there was a patient who's mother kept putting him
in the car seat to sleep. However when I went in the room in the morning, I lifted the baby out of the car seat and the wires/tubes (IV, O2 sat) were
tangled all around the client, including around his neck. I untangled the patient and educated the mother on the way to keep the baby safe in the
hospital crib.
G.O. : Another good example, child safety is an ongoing education we provide to parents. Especially first time parents. Natasha handled that
well and patient was safe in the hospital crib with side rails up.

1. 6 Question and clarify unclear orders or directions and when uncertain.

Satisfactory

Satisfactory

Satisfactory

Satisfactory

N.E. : I always clarified anything that I was uncertain of when I encountered it.

1. 7 Question, clarify or challenge questionable orders, decisions or actions by others.

N.E. : I did not have any orders which I had to question.

G.O. : Even though there were no questionable orders. I educated Natasha on clarifying physician orders whenever in doubt. Never to assume0

1. 8 Respond in a professional manner to situations in which there is unsafe, unacceptable or

Satisfactory

Satisfactory

Satisfactory

Satisfactory

unprofessional behavior.
N.E. : I did not witness any unsafe, unacceptable, or unprofessional behaviour.

1. 9 Demonstrate understanding about the role of the nurse within health care.
N.E. : I believe that I consistently demonstrate that I understand the role of the nurse within health care.

Teacher comments for Model safe, competent, and ethical practice in compliance with legal and regulatory frameworks and the policies
and procedures of the practice setting. :
Natasha understood the importance of safety in nursing practice and especially in paediatric. The hospital policy binder was made accessible to her, I
verbally explained some important policies to her as well, such as always double checking medications with another nurse before administering for
safety reasons since most of our medications are based on dosage calculations with patient's weight.
I am very satisfied with how Natasha demonstrated and showed competence in providing safe care.

Advisor comments for Model safe, competent, and ethical practice in compliance with legal and regulatory frameworks and the policies and
procedures of the practice setting. :
agreed.

2. Communicate using strategies and technology to effect accurate and timely information sharing including data, research, and other
information.

2. 1 Contribute to team sharing and discussions.

Satisfactory

Satisfactory

N.E. : I have been able to demonstrate this by take and giving report at the beginning/end of shift. I have also been able to communicate with the
nursing staff in relation to other patients.

G.O. : Team sharing is important in our unit and Natasha was involved in team sharing , e.g consulting with lactation nurse when mother's were
having breastfeeding issues, referring patient's to social worker when needed.

2. 2 Document clearly, accurately, concisely in a timely manner using written and electronic methods.

Satisfactory

Satisfactory

N.E. : I consistently document throughout the day on vitals, IV infused volumes, ADL's, assessments, etc. I believe that my ability to document daily
patient notes has grown from the first week.

2. 3 Use effective communication techniques when reporting relevant information and providing

Satisfactory

Satisfactory

feedback to the appropriate members of the interprofessional heath care team.

N.E. : This is an area where I feel as though I have grown from the first time I attempted to report. For example, I am now clear on which patient I am
referring to by starting with the room number. I focus on the relevant information and am able to give a full report at the end of shift.

G.O. : Natasha understood the importance of communicating relevant information with other team members.

2. 4 Evaluate and refine techniques used to communicate and share information with clients and the

Satisfactory

Satisfactory

interprofessional health care team.

N.E. : I have grown from week one when I would communicate with clients and the health care team. I have become more confident, therefore with
clients/parents I'm better at providing information and education. With the health care team I am better able to give report and report information about
clients in an effective manner.

2. 5 Ensure privacy and confidentiality.

Satisfactory

Satisfactory

Satisfactory

Satisfactory

N.E. : I always think about and ensure privacy and confidentiality is upheld.

2. 6 Use technology to retrieve information including research and other date and to obtain and
forward information both within and outside the practice setting.

N.E. : I consistently use research/data and technology to retrieve information. One website I have used consistently is Lexicomp, which is a medical
drug database, and http://www.aboutkidshealth.ca which is a website created by Sick Kids and provides information on all childhood illnesses

G.O. : I introduced Natasha to the sick kids website aboutkidshealth.ca , this website explains different diagnosis in children, signs and symptoms,
treatment plan and what to look out for. Very useful and accurate.

Teacher comments for Communicate using strategies and technology to effect accurate and timely information sharing including data,
research, and other information. :
Communicating with other nurses, doctors and multidisciplinary team is a very important aspect of our unit and that was well demonstrated. We have
the child life workers and students who are a big help for destruction and play time with patients, as well as social workers, lactation nurses, OT , PT
and Dietitians who all contribute to patient care. Natasha was also part of our weekly hurdles to discuss pt concerns and staff concerns.

Advisor comments for Communicate using strategies and technology to effect accurate and timely information sharing including data,
research, and other information. :
agreed

3. Engage in relational practice that is caring, compassionate and respectful.

3. 1 Establish therapeutic caring, compassionate, and culturally safe relationships with clients and

Satisfactory

Satisfactory

health care team members.

N.E. : I believe I have been successful at this. For example, one patient was aggressive when I first entered the room to do vitals. I did a basic
assessment, let her calm down, and went back in a bit later. I recognized that I likely scared her by waking her up to do vitals, and took a different,
more gentle approach when i went back in. She was calm and receptive for the remainder of the shift.

3. 2 Establish a caring environment that supports clients in meeting their needs and outcomes,

Satisfactory

Satisfactory

managing their illness, or experiencing a peaceful death.

N.E. : I believe I was successful at this. One thing I know from experience is that having a child in the hospital is stressful and emotional. I listened to
parents, attended to their needs, and was supportive when they needed it.

3. 3 Demonstrate therapeutic use of self to foster client well-being.

Satisfactory

Satisfactory

N.E. : I believe I have continued to demonstrate this consistently. I ensure that I come with a positive attitude in which patients and their families can
trust, and this seems to be communicated with their attitude towards me. I ensure to care for patients using skill and knowledge, and if this isn't
possible, I consult my preceptor or other nurses.

3. 4 Utilize relational knowledge and skills, and ethical principles to support clients and to interact

Satisfactory

Satisfactory

with health care providers.

N.E. : This is something which I believe I have been able to demonstrate and grow stronger at over the course of the semester.

3. 5 Use self-awareness to identify the effects that beliefs, values, and personal experiences have on

Satisfactory

Satisfactory

relational practice.
N.E. : I believe that I use self awareness on a daily basis. It is something that I still think of on often, and ensure I keep in mind.

3. 6 Collaborate with clients, members of the interprofessional and health care teams; and, consult

Satisfactory

Satisfactory

appropriately.
N.E. : There are not many opportunities to collaborate with other teams and most of the people on the unit are doctors and nurses. However I have
spoken to social workers and lactation consultants.

3. 7 Uphold practices and systems that support the diversity of clients and of the interprofessional

Satisfactory

Satisfactory

health care team.

N.E. : One way we did this was by always asking patients about diet restrictions due to religion or cultural beliefs, and respecting this.

3. 8 Provide effective client education.

Satisfactory

Satisfactory

N.E. : One example of this is when the mother of a 5 month olf patient was feeding him more pedialyte than formula. The patient was not vomiting,
did not have diarrhea, and was on IV fluids. I let her know that she should decrease the amount of pedialyte and focus on formula, and the reason
why. She asked questions about why he was spitting up the formula so I let her know that it too much too frequently, and he had a lot of mucous. We
discussed how often she should feed and how much.

Teacher comments for Engage in relational practice that is caring, compassionate and respectful. :
Satisfactory: Natasha was caring, showed compassion and treated patients, family members and other colleagues with respect.

Advisor comments for Engage in relational practice that is caring, compassionate and respectful. :
agreed.

4. Act as a leader and an advocate to empower clients, self, the interprofessional health care team and to further the profession.

4. 1 Evaluate and refine leadership skills to develop solutions, resolve conflict, create a positive work

Satisfactory

Satisfactory

Satisfactory

Satisfactory

environment and organizational culture, and to strengthen advocacy role.

N.E. : I have not had an opportunity to do this.

4. 2 Provide feedback to peers and accept feedback from peers and members of the
interprofessional health care team.

N.E. : I willingly accept feedback from my preceptor and the nurses, as that is the only way I'll learn! The feedback I provide is based on the feedback
I get, as I want others to know how their information worked.

4. 3 Advocate for clients, self, others, and quality practice environment.

Satisfactory

Satisfactory

N.E. : I believe I have been satisfactory in this because I am always thinking about what the needs are for everyone. For example, there was a
patient who was sleeping when it was time to do vitals at the beginning of the shift (1930hrs). When I went in, it woke her up and she became
extremely agitated, kicking and throwing herself around. I almost became injured in the process. The parents asked for me to come back when she
was settled. For her well being and mine, I went back in an hour and finished what I needed to do. It was less difficult for both of us and I respected
the parents wishes.

4. 4 Support clients rights for self-determination and choice.

Satisfactory

Satisfactory

N.E. : An example of when I demonstrated this was when a patient was admitted with gastritis. He had not vomited in almost 24 hours, and only had
a few minutes of nausea. The Dr discharged him, but the mother wasn't comfortable with leaving. She asked to stay another night and I let her know
she could.

G.O. : Even though the patient was discharged, the mother was very worried and did not want to go home, because our census was low and the was
no need for her to rush out; the patient and mother were allowed to stay one more night.

4. 5 Respond appropriately to unsafe, unacceptable, and unprofessional behaviors.

Satisfactory

Satisfactory

Satisfactory

Satisfactory

N.E. : I did not witness any unsafe, unacceptable, and unprofessional behaviours.

4. 6 Demonstrate public protection and acting in the interests of the public through collaboration and
consultation with other members of the interprofessional health care teams.

N.E. : I demonstrate public protection by ensuring I'm competent, not practising outside of my scope, and staying mentally and physically sound.

4. 7 Contribute to the creation of quality practice strategies and solutions.

Satisfactory

N.E. : I have not had an opportunity to be involved in the creation of quality practice strategies and solutions.

Satisfactory

4. 8 Assign, supervise, teach as appropriate, and provide feedback to unregulated care providers

Satisfactory

Satisfactory

(UCPs) in collaboration with the interprofessional health care team.

N.E. : There are no UCP's on this unit.

Teacher comments for Act as a leader and an advocate to empower clients, self, the interprofessional health care team and to further the
profession. :
Satisfactory: Natasha demonstrated some form of leadership in different situations.

Advisor comments for Act as a leader and an advocate to empower clients, self, the interprofessional health care team and to further the
profession. :
agreed.

5. Integrate the nursing process into all aspects of nursing care and across diverse practice settings.

5. 1 Formulates clinical judgments that meet clients unique and changing health needs and priorities,

Satisfactory

Satisfactory

Satisfactory

Satisfactory

outcomes, and overall condition and incorporates these into evolving plans of care.
N.E. : I believe I was able to demonstrate this and grew stronger as the semester progressed.

5. 2 Devise evidence-informed plans of care that are holistic and client-centred.

N.E. : I have progressed in my knowledge of this since the beginning of the semester. I base my plan of care on the information presented about the
client, and their needs. For example, I had a patient who was admitted for febrile seizure. He had been febrile the previous shift, so instead of
monitoring his temperature q4h, I checked it q2h and as needed in between.

5. 3 Use clinical judgment to assess clients, prioritize needs, outcomes, and nursing interventions.

Satisfactory

Satisfactory

N.E. : I believe I have been able to demonstrate my growing skill of clinical judgement since midterm, as I was able to do all of these above. It is
somewhere where I will continue to learn and grow but I believe I was satisfactory.

5. 4 Collaborate in the evaluation, refinement and modification of plans of care.

Satisfactory

Satisfactory

N.E. : I had experience with this when there was a patient who was to be discharged after an appendectomy. We removed the IV, gave the discharge
papers and advised her to take her time. Awhile later her parents called and she had started throwing up. We had to change the plan of care as she
was now going to stay for observation. When we had given her Gravol previously, we had done so through IV. Since we removed it we now had to
utilize the PO orders for Zofran and Gravol.

5. 5 Safely and competently perform treatments and use techniques, and technology autonomously

Satisfactory

Satisfactory

and in collaboration with clients and members of the interprofessional health care team.
N.E. : I always ensure to perform treatments and nursing care with safety and proper techniques. If I am unsure of how to do it safely, I consult with
my preceptor or another nurse.

5. 6 Collaborate with the clients across the lifespan and with members of the interprofessional health
care team to create a client centered plan of care that is articulated with competence both in writing
and orally.

Satisfactory

Satisfactory

N.E. : I believe I have been able to demonstrate this satisfactorily.

5. 7 Use awareness of own knowledge and skills, the three factors of nurse, client and environment

Satisfactory

Satisfactory

and the practice decision-making framework to guide practice.

N.E. : This is an area where I believe I have remained satisfactory. I always am aware of my knowledge and skills, and where I am limited. I use the
nurse, client and environment to guide my practice.

5. 8 Manage workload, time, and physical resources to provide effective, efficient and ethical care.

Satisfactory

Satisfactory

N.E. : I was able to demonstrate this during clinical. I would consider the clients and their needs when deciding how to provide care.

Teacher comments for Integrate the nursing process into all aspects of nursing care and across diverse practice settings. :
Satisfactory: Natasha integrated the nursing process in patient care buy always Assessing patient first, identify the problem, plan both short and long
term goals, before carrying out any interventions and evaluating.

Advisor comments for Integrate the nursing process into all aspects of nursing care and across diverse practice settings. :
agreed.

6. Collaborate and consult with clients and the interprofessional health care team to provide comprehensive and holistic health care in a
complex and changing environment.

6. 1 Collaborate with clients to determine needs, mutually agreed health outcomes, approaches to

Satisfactory

Satisfactory

care, and to evaluate care.

N.E. : This is something that is done on a daily basis. For example, one patient was really upset when I came into the room to do vitals and she also
had a schedule inhalation. So we talked with the mother and determined that she would do it after we left the room and she had supper. When I went
back in later, this worked and the patient was able to do the inhalation with minimal resistance. Whereas if I had been there she likely would have
continued screaming and kicking.

6. 2 Contribute as a member of the interprofessional and health care teams to respond to changing

Satisfactory

Satisfactory

client needs and outcomes.

N.E. : I have been able to demonstrate this throughout the semester. For example, patients who are admitted due to fevers, require monitoring as
their needs can change quickly.

6. 3 Consult with and seek out assistance from members of the interprofessional health care team.

Satisfactory

Satisfactory

N.E. : Whenever needed, I seek out assistance and consult with the health care team. This is something I have done throughout the semester.

6. 4 Use teamwork, consensus building, and conflict resolution and leadership skills to meet

Satisfactory

Satisfactory

expected client outcomes.

N.E. : I have successfully demonstrate teamwork and consensus building throughout the semester. I often work as a team player and feel as though
this is a strength.

6. 5 Integrate effective, collaborative, and consultative strategies to meet clients needs within a
changing environment.

Satisfactory

Satisfactory

N.E. : I believe I was able to demonstrate this and grew stronger as the semester progressed. I would consult with my preceptor and other nurses to
meet the clients needs.

6. 6 Respect the unique role and competencies of all members of the interprofessional health care

Satisfactory

Satisfactory

Satisfactory

Satisfactory

team.
N.E. : I believe I demonstrated this on a daily basis.

6. 7 Collaborate as a member of the interprofessional health care team to respond to changes in

nursing knowledge and practice and in the health care environment.
N.E. : This is not an area that I have been exposed to.

Teacher comments for Collaborate and consult with clients and the interprofessional health care team to provide comprehensive and
holistic health care in a complex and changing environment. :
Satisfactory

Advisor comments for Collaborate and consult with clients and the interprofessional health care team to provide comprehensive and
holistic health care in a complex and changing environment. :
agreed.

7. Engage in Quality Assurance consistent with the regulatory framework.

7. 1 Act in the best interests of clients and protect clients from harm through collaboration and

Satisfactory

Satisfactory

consultation with other members of the interprofessional and health care teams and by through
competent and safe practice.
N.E. : I believe I have been satisfactory at this. I constantly used my knowledge and judgement to protect patients from harm and use safe practice.

7. 2 Commit to Quality Assurance practice to identify strengths and areas for professional growth and

Satisfactory

Satisfactory

in accordance with the regulatory framework (CNO).

N.E. : I believe I have demonstrated this by creating a learning plan this semester. I was able to identify where my strengths are, and where I can
improve.

7. 3 Create, implement, and evaluate a learning plan consistent with the Quality Assurance program

Satisfactory

Satisfactory

(CNO).
N.E. : I have done this over the past few weeks, and will be implementing and evaluating my progress on my areas of focus. I have implemented my
learning plan from semester 2 and saw successful results from following my outline.

7. 4 Assume responsibility to seek out feedback for colleagues and peers and learning opportunities

Satisfactory

Satisfactory

Satisfactory

Satisfactory

that foster professional development.

N.E. : I seek out feedback consistently and use it to further my knowledge and skills.

7. 5 Consistently review nursing research and information about health care to improve competence
and to support clients.

N.E. : I demonstrated this by looking up drug information or information about conditions that I wasn't familiar with. I researched information about
tests that I had not been exposed to. In addition if there was anything taped up around the nurses station, I would read it (i.e. an article on
management of bronchiolitis).

7. 6 Develop professional responses to health care system changes resulting from advances in

Satisfactory

Satisfactory

research, technology, and changes in societal and political forces.

N.E. : I believe I demonstrated this in one of my classes where I examined medication errors and possible ways to avoid them, by using changes in
the health care field.

Teacher comments for Engage in Quality Assurance consistent with the regulatory framework. :
Natasha understood the importance of quality assurance in paediatric nursing, again by double checking dosage calculations and expiry dated on
meds. Always identifying the patient by checking ID bands, checking patient allergies. All these are important and followed by Natasha on our unit.

Advisor comments for Engage in Quality Assurance consistent with the regulatory framework. :
agreed.

8. Use critical thinking, problem solving and decision making skills to meet the health care needs and expected outcomes of clients.

8. 1 Use critical thinking to inform decision making in all aspects of nursing care.

Satisfactory

Satisfactory

N.E. : Critical thinking is something in which I use on a daily basis. it's an area however in which I know I need to continue developing. It's important
for safe nursing care.

8. 2 Use clinical judgment to assess and refine assessments in collaboration with the

Satisfactory

Satisfactory

interprofessional health care team, formulate nursing diagnoses, plan nursing interventions, and
outline evaluative criteria.
N.E. : This is something I do on a daily basis. Based on assessments, I have to formulate nursing diagnoses, plan nursing interventions, and outline
evaluative criteria, and then re-assess. For example, a patient who was in pain due to a tonsillectomy was given tylenol. 2 hours later she was in pain
again, but couldn't have more tylenol. I had to re-assess and come up with ways to help her.

8. 3 Evaluate and refine critical thinking, problem solving, and decision-making skills.

Satisfactory

Satisfactory

N.E. : As the semester has progressed I have been able to refine these skills, as I'm building off of information learned in school. and throughout
other clinical. I have learned new skills and used those to continuously evaluate how I look at and handle situations and apply the above skills.

8. 4 Integrate knowledge from variety of nursing, health, and other theory into nursing practice to

Satisfactory

Satisfactory

provide safe and competent care.

N.E. : I have been able to do this as I have been reviewing nursing class notes throughout the semester. I also use knowledge from my own
research, to make sure I provide safe care.

8. 5 Prioritize effectively.

Satisfactory

Satisfactory

N.E. : I always try and consider the situation when deciding which patient to attend to first. When documenting, I document all vitals and then go
back and document other information.

8. 6 Demonstrate professionalism, responsibility, and accountability.

Satisfactory

Satisfactory

Satisfactory

Satisfactory

N.E. : I demonstrate these three on a daily basis.

8. 7 Use critical thinking, the practice decision-making framework and the nurse-client-environment
framework to inform clinical judgments and practice.

N.E. : I demonstrate this by ensuring I look at the three factor framework when I provide nursing care. It's important to understand the nurse, client,
and relationship and how they effect my practice as a student as there are areas where I'm not competent and need more practice and knowledge.

Teacher comments for Use critical thinking, problem solving and decision making skills to meet the health care needs and expected
outcomes of clients. :
Satisfactory: Natasha demonstrated critical thinking skills, and example will be when Natasha assessed a patients IV site and compared to the other
hand and noticed swelling, IV was interstitial; first reaction was she stopped the IV from infusing, informed me and I also assessed removed the IV
from site immediately. The IV site was swollen, patient was asked to elevate hand as much as possible. This is just an example of critical thinking.

Advisor comments for Use critical thinking, problem solving and decision making skills to meet the health care needs and expected
outcomes of clients. :
agreed.

9. Final Exam Results

9. 1 Final Exam Results

Satisfactory

Teacher comments for Final Exam Results :

Overall Natasha was a good student. Always anxious to learn new skills, answering call bells even if she was not assigned to that particular patient.
Natasha was an asset to our unit. She was very respectful, punctual and well liked by the team. I am satisfied with her placement and would even
advocate for her to come work with us on the unit.

Advisor comments for Final Exam Results :

student worked well with preceptor and health care team as evident during visits to the clinical setting.

Student Final Summary with Strategies for Continued Growth

- Work on learning plan and QA, evaluate and refine
- Review theory information
- Reflect on my practice over the past 4 months to determine more areas of growth and strengths
- Increase my confidence in nursing care being provided

Teacher Final Summary with Strategies for Continued Growth

Natasha just needs to keep learning and improving on new skills as we all do in nursing. I advised her to always have a plan and goal to improve
herself in all aspects of her carrier. Always follow facility protocols and regulations. Follow the practise within her scope and always ask questions
whenever in doubt. Collaborate with colleagues all the time and learn from experienced colleagues. Always clarify orders and double check orders
and medications to avoid mistakes.

Advisor Final Summary with Strategies for Continued Growth

continue to review theory. Always keep up to date with new practices according to the CNO guidelines.

Student's References
CNO Practice Guideline - RN and RPN Practice: The Nurse, The Client, and The Environment
CNO Practice Standard - Ethics
http://www.cno.org/en/myqa/qa-resources/

Refer to Clinical Excellence Committee (CEC)

Grade

Satisfactory

Unsatisfactory

Program Coordinator Feedback

The Program Coordinator has reviewed the evaluation

Yes

No

Student Sign Off

I met with my Clinical Teacher/Preceptor and discussed my evaluation

Yes

No

In general this evaluation accurately reflects my performance

Yes

No

Student Comment
I agree and accept the feedback.

Submitted Date: 23-Apr-2016 05:06