Survey: "Affective Clinical Evaluation Level I"

Reviewer: Clinical Instructors (WOJNO, Melissa)

Reviewee: Students (Zehnder, Timothy)
Survey Period: 5/7/2024
Completed: 5/7/2024 9:48:06 AM CT

1. First semester Evaluation:

3rd 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 Meets Expectations [10 pts]
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: 40 Score: 100.0%

9. I have reviewed this evaluation with the student.

No

10. Additional Comments:

Tim has really blossomed during his time with us. He is eager to learn and take on difficult cases. He knows when to ask for help and when to work on his
own. I am extremely impressed with his time here and look forward to continuing to work with him. other preceptor comments: A student who is excellent,
outstanding and goes above and beyond. He is working an entire semester ahead on comps. He is always willing to stay busy and take on any task/plan no
matter how easy or difficult planning parameters are. Excellent communication skills and works well with physicians, physics and all staff.

Total points for all rating scale questions: 260

Mean percentage score for all rating scale questions: 100.0%
(Each main question equally weighted)
Responses as of 5/7/2024 2:50:35 PM CT