Student Evaluation of Off-Campus Practicum and Supervisor

Student Evaluation of Off-Campus Practicum and Supervisor

Department of Speech and Hearing Sciences

4th Year Externship: Clinical Competency Inventory*

RATING SCALE: / 5 / Independently demonstrates skill in a variety of challenging and complex clinical situations. Uses evidence based, best practice methods. Collaborates with others when needed.
4 / Independently demonstrates skill in routine or typical clinical situations. Relies on input from supervisor in complex, challenging, or atypical situations. Seeks guidance when needed.
3 / Requires frequent guidance and/or instruction from supervisor to execute skill. Requires consistent monitoring from supervisor. Responds positively to guidance and instruction and demonstrates improvement in skills.
2 / Requires constant guidance and instruction from supervisor to execute sill, even in routine, predicable clinical situations. Demonstrates difficulty with accurate self-assessment of clinical skills.
1 / Is unable to execute clinical skill even with maximal guidance and instruction from supervisor.
NA / Not applicable, or no opportunity to observe in setting.
Evaluations Skills / *Adopted from the ASHA Clinical Fellowship Skills Inventory (CFSI), ASHA, 2000.
1. / Implements screening procedures including selecting appropriate screening criteria, administering and scoring screening instruments, interpreting results, and making appropriate recommendations.
*2. / Collects and integrates case history information through questionnaires and interviews, probes for relevant information, and identifies etiologic and or contributing factors from case history data. Uses case history information to formulate key assessment questions.
*3. / Selects, administers, and interprets behavioral tests of auditory sensitivity using frequency-specific stimuli, demonstrating clear understanding of test rationales and accurate administration of best practice procedures.
*4. / Selects, administers, and interprets acoustic immittance tests demonstrating clear understanding of test rationales and accurate administration of best practice procedures.
*5. / Selects, administers, and interprets speech tests (threshold and recognition) demonstrating clear understanding of test rationales and accurate administration of best practice guidelines.
6. / Selects, administers, and interprets electrophysiologic tests (e.g. auditory evoked potentials, tests of balance and vestibular function, otoacoustic emissions, neuromuscular testing) demonstrating clear understanding of rationales and accurate administration of best practice guidelines.
7. / Selects, administers, and interprets test of central auditory function/processing (e.g. adaptation, loudness function, dichotic, diotic) demonstrating clear understanding of rationales and accurate administration of best practice guidelines.
*8. / Integrates and synthesizes test results, behavioral observations, and information gained from all sources to develop diagnostic impressions and make recommendations appropriate for each client’s academic, vocational and social situation.
Intervention Skills
*9. / Selects ear molds, personal amplification, and/or assistive listening devices inconsideration of evaluation data and each individual’s personal needs and preferences.
*10. / Takes impressions of the ear for personal amplification systems, swim molds, and personal hearing protection, and makes modifications as needed taking into account conditions of the ear, ear mold type, acoustic factors, hearing aid type, degree of hearing loss, client’s age, and dexterity.
*11. / Validates fitting, orients client with personal amplification and listening systems, discusses communication strategies, and provides post-fitting counseling in a manner that actively involves client in the intervention process.
12. / Plans and implements aural habilitation/rehabilitation programs working collaboratively with others (physicians, allied health professionals, teachers/educators) to achieve optimal outcome.
13. / Plans and implements amplification portion of aural habilitation/rehabilitation programs for children with hearing impairment within the educational model of service delivery to achieve optimal outcome.
Management Skills
*14. / Schedules and prioritizes direct and indirect service activities and documents professional contacts and clinical reports in a timely manner.
*15. / Complies with administrative policy requirements including reports, statistics, and requests.
16. / Uses local, state, national, and funding agency regulations to make decisions regarding service eligibility and, if applicable, third-party payer reimbursement.
Professional Communication Skills
*17. / Demonstrates communication skills, including listening, speaking, nonverbal communication and writing, taking into consideration the communication needs, as well as the cultural values of the client, family, care givers, significant others, and other professionals.
*18. / Identifies and refers clients for speech-language, educational, medical, psychological, social and vocational services.
*19. / Collaborates effectively with other professionals in matters relevant to case management.
*20. / Provides counseling and supportive guidance regarding the client’s communication disorder to client, family, caregivers, and significant others.
21. / Plans and implements education programs for other professionals and the general public to facilitate prevention, acceptance, and treatment of communication disorders.
Au.D. Extern: / Beginning Date:
Preceptor: / Externship Site:
Segment I
Period Ending Aug.10 / Segment II
Period Ending Dec. 14 / Segment III
Period Ending April 27

AUD Skills Ratings

/ AUD Skills Ratings / AUD Skills Ratings
1 5 4 3 2 1 N/A / 1 5 4 3 2 1 N/A / 1 5 4 3 2 1 N/A
2* 5 4 3 2 1 / 2* 5 4 3 2 1 / 2* 5 4 3 2 1
3* 5 4 3 2 1 / 3* 5 4 3 2 1 / 3* 5 4 3 2 1
4* 5 4 3 2 1 / 4* 5 4 3 2 1 / 4* 5 4 3 2 1
5* 5 4 3 2 1 / 5* 5 4 3 2 1 / 5* 5 4 3 2 1
6 5 4 3 2 1 N/A / 6 5 4 3 2 1 N/A / 6 5 4 3 2 1 N/A
7 5 4 3 2 1 N/A / 7 5 4 3 2 1 N/A / 7 5 4 3 2 1 N/A
8* 5 4 3 2 1 / 8* 5 4 3 2 1 / 8* 5 4 3 2 1
9* 5 4 3 2 1 N/A / 9* 5 4 3 2 1 N/A / 9* 5 4 3 2 1 N/A
10* 5 4 3 2 1 N/A / 10* 5 4 3 2 1 N/A / 10* 5 4 3 2 1 N/A
11* 5 4 3 2 1 N/A / 11* 5 4 3 2 1 N/A / 11* 5 4 3 2 1 N/A
12 5 4 3 2 1 N/A / 12 5 4 3 2 1 N/A / 12 5 4 3 2 1 N/A
13 5 4 3 2 1 N/A / 13 5 4 3 2 1 N/A / 13 5 4 3 2 1 N/A
14* 5 4 3 2 1 / 14* 5 4 3 2 1 / 14* 5 4 3 2 1
15* 5 4 3 2 1 / 15* 5 4 3 2 1 / 15* 5 4 3 2 1
16 5 4 3 2 1 N/A / 16 5 4 3 2 1 N/A / 16 5 4 3 2 1 N/A
17* 5 4 3 2 1 / 17* 5 4 3 2 1 / 17* 5 4 3 2 1
18* 5 4 3 2 1 / 18* 5 4 3 2 1 / 18* 5 4 3 2 1
19* 5 4 3 2 1 / 19* 5 4 3 2 1 / 19* 5 4 3 2 1
20* 5 4 3 2 1 / 20* 5 4 3 2 1 / 20* 5 4 3 2 1
21 5 4 3 2 1 N/A / 21 5 4 3 2 1 N/A / 21 5 4 3 2 1 N/A
Segment I / Segment II / Segment III
PRECEPTOR’S SIGNATURE / PRECEPTOR’S SIGNATURE / PRECEPTOR’S SIGNATURE
Au.D. EXTERN / Au.D. EXTERN / Au.D. EXTERN
DATE OF FEEDBACK SESSION / DATE OF FEEDBACK SESSION / DATE OF FEEDBACK SESSION