Survey: Affective Clinical Evaluation Level I

Reviewer: Clinical Instructors (KENDALL, Dan)

Reviewee: Students (Piercey, Melissa)
Survey Period: 2/20/2023
Completed: 4/3/2023 6:38:47 AM CT

1. First semester Evaluation:

2nd Evaluation

3. Communications

Explains medical dosimetry procedures to N/A

patient as appropriate to situation (e.g.
when assisting with procedures in
treatment room or simulation).

Respects patient's rights to privacy and Meets Expectations [10

confidentiality. pts]

Acts and speaks in a respectful manner Meets Expectations [10

with staff members. pts]

Asks questions in an appropriate manner. Meets Expectations [10

pts]

Accepts correction and direction in a Meets Expectations [10

professional manner. pts]

Contributes as a member of the medical Meets Expectations [10

dosimetry team. pts]

Uses effective verbal communication skills Meets Expectations [10

with physician during plan consultation pts]
and review.

Uses effective written communication Meets Expectations [10

skills for chart, plan, and dosimetry note pts]
documentation.

Mean: 10.00 of 10 Points: 70 Score: 100.0%

4. Accuracy

Follows through instructions with attention Meets Expectations [10

to detail. pts]

Accurately enters information into chart or Meets Expectations [10

R & V system. pts]

Mean: 10.00 of 10 Points: 20 Score: 100.0%

5. Safety

Double checks all student work to include Meets Expectations [10

calculations and treatment plans with pts]
dosimetrist/physicist.

Mean: 10.00 of 10 Points: 10 Score: 100.0%

6. Dependability

Arrives promptly as scheduled. Meets Expectations [10

pts]

Schedules breaks, lunches, and other Meets Expectations [10

time needs with clinical instructors. pts]

Adheres to attendance standards of the Meets Expectations [10

program. pts]

Uses clinical time wisely. Meets Expectations [10

pts]

Follows school and hospital policies and Meets Expectations [10

procedures. pts]

Takes initiative in observing and assisting Meets Expectations [10

in dosimetry activities. pts]

Mean: 10.00 of 10 Points: 60 Score: 100.0%

 7. Application of Knowledge

Demonstrates a basic understanding of Meets Expectations [10

physics concepts and principles. pts]

Is able to retrieve imaging study (CT) and Meets Expectations [10

bring into patient file. pts]

Is able to identify anatomy and contour Meets Expectations [10

appropriate structures. pts]

Understands the use of the computer for Meets Expectations [10

treatment planning. pts]

Is able to enter information into the Meets Expectations [10

computer and design a basic treatment pts]
plan in accordance with prescription.

Mean: 10.00 of 10 Points: 50 Score: 100.0%

8. General Dosimetry Skills

Performs calculations in a timely manner. Meets Expectations [10

pts]

Accurately uses dose calculation Meets Expectations [10

databooks to perform hand calculations. pts]

Is able to prioritize and organize duties to Meets Expectations [10

efficiently complete requirements. pts]

Exhibits a basic knowledge of anatomy, Meets Expectations [10

tissue dose tolerance, definitive tumor pts]
dose, and typical field arrangement.

Mean: 10.00 of 10 Points: 40 Score: 100.0%

9. I have reviewed this evaluation with the student.

Yes

10. Additional Comments:

keep up the good work!

Total points for all rating scale questions: 250 (Each main question equally weighted)
Mean percentage score for all rating scale questions: 100.0% Response as of 4/27/2023 11:55:03 AM CT