Survey: Affective Clinical Evaluation Level I

Reviewer: Clinical Instructors (ROCQUE, Michelle)

Reviewee: Students (Mitchem, Jessalyn)
Survey Period: 3/31/2023
Completed: 4/3/2023 9:18:12 AM CT

1. First semester Evaluation:

2nd Evaluation

3. Communications

Explains medical dosimetry procedures to patient as appropriate to Meets Expectations [10 pts]
situation (e.g. when assisting with procedures in treatment room or Additional Comment: Jessalyn is always very attentive to the patient when she
simulation). assists, and she always introduces herself when appropriate.

Respects patient's rights to privacy and confidentiality. Meets Expectations [10 pts]

Acts and speaks in a respectful manner with staff members. Meets Expectations [10 pts]

Asks questions in an appropriate manner. Meets Expectations [10 pts]

Accepts correction and direction in a professional manner. Meets Expectations [10 pts]

Contributes as a member of the medical dosimetry team. Meets Expectations [10 pts]
Additional Comment: Jessalyn has begun to review the schedule and anticipate
which patients she can complete.

Uses effective verbal communication skills with physician during Meets Expectations [10 pts]
plan consultation and review.

Uses effective written communication skills for chart, plan, and Meets Expectations [10 pts]
dosimetry note documentation.

Mean: 10.00 of 10 Points: 80 Score: 100.0%

4. Accuracy

Follows through instructions with attention to detail. Meets Expectations [10 pts]

Accurately enters information into chart or R & V system. Meets Expectations [10 pts]

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

5. Safety

Double checks all student work to include calculations and Meets Expectations [10 pts]
treatment plans with 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 time needs with clinical Meets Expectations [10 pts]
instructors.

Adheres to attendance standards of the program. Meets Expectations [10 pts]

Uses clinical time wisely. Meets Expectations [10 pts]

Follows school and hospital policies and procedures. Meets Expectations [10 pts]

Takes initiative in observing and assisting in dosimetry activities. Meets Expectations [10 pts]
Additional Comment: Jessalyn has begun following her patients from planning to
treatment.

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

7. Application of Knowledge

Demonstrates a basic understanding of physics concepts and Meets Expectations [10 pts]
principles.

Is able to retrieve imaging study (CT) and bring into patient file. Meets Expectations [10 pts]

Is able to identify anatomy and contour appropriate structures. Meets Expectations [10 pts]

Understands the use of the computer for treatment planning. Meets Expectations [10 pts]

Is able to enter information into the computer and design a basic Meets Expectations [10 pts]
treatment 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 databooks to perform hand N/A

calculations.

Is able to prioritize and organize duties to efficiently complete Meets Expectations [10 pts]
requirements.

Exhibits a basic knowledge of anatomy, tissue dose tolerance, Meets Expectations [10 pts]
definitive tumor dose, and typical field arrangement.

Mean: 10.00 of 10 Points: 30 Score: 100.0%

9. I have reviewed this evaluation with the student.

No

10. Additional Comments:

Jessalyn continues to improve on treatment sites that have completed competencies as well as attempting new sites and planning techniques. She continues to
observe and take excellent notes that help her work independently.
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 5/8/2023 10:17:23 AM CT