CLINICAL PRACTICUM II STUDENTASSESSMENT FORM

Practicum III (MeLS 402) = 3chrs

Student: _______________________________ Department: _____________________

Directions to assessing supervisor: Select the number that best describes the student’s performance in
this section of the laboratory and mark an “X” in the appropriate box. Use the comment spaces to make
Use the comment spaces to make any additional comments. Write NA, if you are unable to rate the
student in a particular category.

Performance Scale

1 = Unacceptable performance: Student consistently did not display desired skill and
knowledge.
2= Inconsistent performance: Student requires constant, detailed supervision in order to
perform in the laboratory with limited skill and knowledge.
3 = Average Performance: Student demonstrates acceptable skill and knowledge with
minimum supervision.
4 = Above Average Performance: Student demonstrates above average skill and knowledge.
5 = Excellence Performance: Student demonstrates high level skill and knowledge and works
independently.
Skill/procedure Minimum number Performance Date Sign
Scale completed
Observed Assisted Performed 5 4 3 2 1
General skills
Follows all safety procedures
Learns new procedures in a reasonable amount
of time
Follows laboratory procedures and protocols
Differentiates normal and abnormal results
Discusses the theoretical basis for laboratory
tests & demonstrates knowledge of assigned
reading
Plans and organizes work effectively and
efficiently
Possesses technical skills of an entry level
technician
Calculates, transcribes and reports data
accurately
Clinical Chemistry
Apply techniques of preparation of standard
solution, buffer solutions
Glucose determination
Amino acids and protein determination
Lipid and lipoprotein, cholesterol, triglyceride
determination
Bacteriology II
Perform procedures involved in isolating,
particularly those of medical importance.
Perform biochemical tests to identify bacteria,
particularly those of medical importance.
Perform antibiotic susceptibility test
Interpret antibiotic susceptibility test
Hematology II
Perform hematological tests for the diagnosis
of anemia.
Examine and interpret red cell morphology
Perform and interpret osmotic fragility of red
cells
Perform hematological tests for the diagnosis
of leukemia.
Perform hematological tests using
hematological automation
Identify and report leukemic cells
Perform bleeding tests for vascular defects,
platelet defects & blood coagulation factor
defects.
Examination of Bone Marrow smears
Examine and Identify of L.E cells
Parasitology II
Apply the necessary procedures for the
laboratory diagnosis of intestinal protozoan
parasites.
Examine blood smear (thick and thin)
preparation for the identification of
haemoparasites.
Total Summation Score

COMMENT___________________________________________________________________
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Instructor Name and Signature____________________________________________________