Survey: "Affective Clinical Evaluation Level I"

Reviewer: Clinical Instructors (JACOBSON, Kevin)

Reviewee: Students (Bentz, Kearla)
Survey Period: 4/6/2023
Completed: 4/6/2023 3:31:30 PM CT

1. First semester Evaluation:

2nd Evaluation

3. Communications

Explains medical dosimetry procedures to patient as Meets Expectations [10 pts]

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

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]

Uses effective verbal communication skills with physician Meets Expectations [10 pts]
during 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 Meets Expectations [10 pts]
activities.

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 Meets Expectations [10 pts]
basic 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.

Yes

10. Additional Comments:

Kearla has been an excellent student! She is self motivated and is capable of jumping in and starting on a new treatment plan without being asked. She
shows a willingness and drive to learn and is producing excellent treatment plans. She is a great asset to our department.

Total points for all rating scale questions: 250

Mean percentage score for all rating scale questions: 100.0%
(Each main question equally weighted)
Responses as of 4/8/2023 6:35:53 PM CT