AOTA 22 ZX Association, inc: Fieldwork Performance Evaluation For The Occupational Therapy Student wm _NizKon Mao, SIGNATURES: NAME (LAST) FRBNY (MHODLEY | HAVE READ THIS REPORT. Wnuver ctu, of Utah COLLEGE OR UNIVERSITY ecg. higher ‘SGNATURE OF STUDENT FIELDWORK SETTING: \nkermonntain Medical Center \ ‘AME OF ORGANIZATONFAGIETY NUMBER OF PERSONS CONTRIBUTING TO THIS REPORT ‘ADDRESS. STREET OR PO BON) 25 av SRE a ‘SIGNATURE OF RATER bapatent Acute “Wehasa eg ex ‘TYPE OF FIELDWORK PRINT NAME/CREDENTIALSIPOSITION ORDER OF PLACEMENT(D.2 3 4 OUTOF 1B 94 rot May \2 201 w fru 21, 201%, . (DATES OF PLACEMENT SIGNATURE OF RATER #2 (IF APPLICABLE) [RUMBER OF HOURS COMPLETED PRINT NANE/GREDENTIALSIPOSITION \aS FINAL SCORE pass: SC NO Pass: ‘SUMMARY COMMENTS: (ADDRESSES STUDENTS CLINICAL COMPETENCE)a RATING SCALE FOR STUDENT PERFORMANCE. 4— Exceeds Standards: Performance is highly skilled and solt-nitte, This ang is rarely given ard would represent the top 5% of al the students you have supervised Meets Standards: Prtormance is consistent wih entry-level practice This ating is infrequently given at midterm andi a strong rating at fina Needs improvement: Peormance is progressing but sill nods improvement for enryovel paces This is a realistic rating of Performance at midterm, and some ratings o 2 maybe reasonable at the fal Unsatistactory: Performance is below standards and requies velopment or enty-4evopracte. This rating Is given when thee is ‘ concer about performance I EVALUATION AND SCREENING: ‘Articulates a clear and logical rationale forthe evaluation process. wom 12 ma 1 kG) Selects relevant screening and assessment methods wile considering such factors as cent’ priorities, contexts), theories, and evidence-based practice. wien + 2 4 fa = 1k 10. Determines client's occupational profile and performance through appropriate assessment methods. Midterm 1 2 4 Final 1 2 @ 4 1. Assesses client factors and context(s) that support or hinder ‘ocupational performance won 12 OA re eee 12, Obtains sufficient and necessary information from relevant resources such as dient, families, signifieant others, service providers, and records prior to and during the evaluation process. Final 1 2 DB 4 13, Administers assessments ina uniform manner to ensure findings are valid and reliable witem 1 2 G4 Final + 2 @ 4 14, Adjusts/madifies the assessment procedures based on clent’s needs, behaviors, and cuture. Midterm 1 2 Final 1 2 16, Interprets evaluation results to determine cients occupational performancs strengths and challenges, Midterm 4 2 4 Final 1 2 4 16, Establishes an accurate and appropriate plan based on the ‘evaluation results, through integrating multiple factors such as Cent’ priorities, contexts), theories, and evidence-based practi. ~ 11 et 17. Documents the results ofthe evaluation process that demon- strates objective measurement of client's occupational perform- ance, Midterm 1 28 Final 1 2 3 @ ‘Comments on strengths and areas for improvement: + Midterm Final Hepessed Comgloy es a taconlyded AgerrRrere Glan, IV. INTERVENTION: 18, Articulates a clear and logical rationale forthe intervention process, Waem 1 2 Qo 4 Final + 2 @) 4 18, Usilzes evidence from publshed research and relevant resources to make informed intervention decisions Midterm 1 2 3 4 mt 1 2 @) 4 Yer geod € fhcrert cecsuninhr? 20, a 2, a 24, % Es (Chooses occupations that motivate and challenge cents Mitem 1 92 8 4 &) 4 Selects relevant occupations to facitate cients meeting esta- lished goals Wien i 0208 4 fal to A Implement intention pasta recent contre Wem =t 2 8 fd 1k | Implements intervention plans that are occupation-based. wom +28 rn) Modifies task approach, occupations, and the environment fo ‘maximize client performance. Midterm 1 2 3 4 Final 1 2 OD 4 Updates, modities, or terminates the intervention plan based ‘upon careful monitoring ofthe clients status Midterm 1 2 34 fr tk @ Documents client's response to services in a manner that demonstrates the efficacy of interventions Midterm 4 2 34 fa = tk ®t Final 1 2 Comments on strengths and areas for improvement: ‘+ Midterm . 7 ujc Aten > Aoccuugacion Wes ‘ Areadnert oe \V. MANAGEMENT OF OCCUPATIONAL THERAPY SERVICES: 27. Demonstrates through practice or discussion the ability to assign appropriate responsibilies tothe cocupatonal therapy assistant and occupational therapy alde. Midterm 1 2 3 4 fod = tk @ 28, Demonstrates through practice or discussion the ability to actively collaborate with the occupational therapy assistant Midterm 4 2 3 4 fm = tk] 4 29, Demonstrates understanding of the costs and funding related to occupational therapy services at his sit Midterm 1 2 3 4 Final 1 2 @ 4s 30, Accomplishes organizational goals by estabishing priorities, veloping strategies, and meeting deadlines. Midterm 2 3 4 Final 1 2 ®© 4 31, Produces the volume of work requied in the expected time frame, Mien 128 ma 1 28 Comments on strengths and areas for improvement: stem Final wa Keres OF Being ad BUEN ob 95, Cnt qronde shgrey wea lie [omer Th baby CAKWLAK SeAgIONG froet crahyngins | qpadedl aGhveties We ergregs ghRATING SCALE FOR STUDENT PERFORMANCE 4— Exceeds Standards: Performance is highly skild and sol-inited ‘This ratings rarely given and would represent the top §% of all the students you have supervise. 3—Meots Standards: Perirmanceis consistent with entryfevel practice, ‘This rating is infrequently given at midterm and sa strong rating at fina 2—Neods improvement: erirmance Is progressing but stil needs improvement or ennyivel racic. This is a realistic rating of Performance at midterm, and some ratings o 2 may be reasonable at the tna 11 —Unsatistactory: Porrmance is below standards and requires development or etry eel practice This rating is given when there is ‘a concern about performance VI. COMMUNICATION: 2, Clearly and effectively communicates verbally and nonverbak- ly with cients, families, significant others, colleagues, service providers, and the public. Midterm 1 2 3 4 Fri tk 38, Produces clear and accurate documentation according to ste requirements Midterm 1 2 3 4 Flt 23 @D 34, All written communication is legible, using proper speling, punctuation, and grammar. Midterm 4 2 3 4 Flt 28 A) 35. Uses language appropriate tothe recipient of the information, including bt nt imited to funding agencies and regulatory agen- ces. Wom 28 ma 12) 4 Comments on strengths and areas for improvement: vam + Final Good dramendekiay Poa wun Se Sere opsprokessinal oy eg VII PROFESSIONAL BEHAVIORS: 36, Collaborates with supervisor(s) to maximize the learning experience. Midterm 4 2 3 4 fr = tk 37, Takes responsibilly for attaining professional competence by ‘seeking out learning opportunities and interactions with supervi- sor(s) and others. Mitem 1 92 9 4 Fra 1 2 @ 4 38, Responds constructively to feedback. Mitem = 1 B84 fr = 1 2 @ 39, Demonstrates consistent work behaviors including inatve, preparedness, dependabilty, and work ste maintenance. idem = 1 29 ft = tk 40. Demonstrates effective time management. Wem 1 2 9 4 m1 2 KY © 41. Demonstrates positive interpersonal skills including but not m- ited to cooperation, flexibly, tact, and empathy. Midterm 1 2 38 4 ra 12 @ 42. Demonstrates respect for diversity factors of others including but not limited to soci-cutural, socioeconomic, spiritual, and itestyle choices. Midterm 1 2 38 4 Final 1 2 © 4 Comments on strengths and areas for improvement: + Midterm + Final Pere, “LOL H eGHEL © VS Good Wmonmngpnant PERFORMANCE RATING SUMMARY SHEET Performance ems ict Ratings |, FUNDAMENTALS OF PRACTICE 1. Adheres to ethos + 2. Adnetes to sally regulations 3, Uses judgmentin safety 1 BASIC TENETS OF OCCUPATIONAL THERAPY 4 Aiculatas valves and belies 5. Atculates valve of occupation 6 Communicates role of occupational theraist Final Ratings | wc. 7. Collaborates with clients lil, EVALUATION AND SCREENING 8. Arcuales cereale or evan 9. Seles reliant methods 10, Daerinescocupatnal prfie AI a) | has | “1 Assesses cient and contextual ators 12. Obtains sufficient and necessary information 73 Adminsirs assessments “4. Adustsimoctis assessment procadures 15. Irierpres evaluation results 16 Establishes accurate plan 47 Documents resus of evalton| IMINTERVENTION 18. Ariciates lar rationale frntrvention 1. Uilzes evidence to make informed decisions 20. Chooses oocupatons thal motvate and challenge 21. Seocs relevant occupations - 22. Implements cent centered interventions 23, Implements oosupation based interventions 24. Modifies approach, cccupation ad environment 25. Updates, mies, or ermintesinferenton pan 26. Documents cients response \. MANAGEMENT OF OT SERVICES | 27 Demnonstaes ably to assign though pace or discussion 28. Demonstals ality io colaborate rough pracoe or discussion 29, Understands costs and funding 30, Accomplshes organizational gol 3. Produces workin expeced timeframe Vi. COMMUNICATION 32. Communicates verbal and rowerbally 383. Produces clear documentation 4. Witen communication i legible 35. Uses language appropate io recipient VIL PROFESSIONAL BEHAVIORS | 36. Colaborates wih supervisor 537, Takes responsbilty for professional competence 38, Responds constructively to feedback 39, Demonstrates consistent work bhavio 40, Demonstrates time menagement 41. Demonstates postive interpersonal IB | 42, Demonstats reapoct fr dversiy ‘TOTAL SCORE MIDTERM: FINAL: Salistactory Performance. 90 and above Pass Unsatistactory Performance. 89 and below No Pass |e] 0 2 Lortete}olas| ola lajajofse | | oP Fwlelse << : 122 points and above «121 points and below