SWOSU - Surveys & Evaluations

SOUTHWESTERN OKLAHOMA STATE UNIVERSITY

SCHOOL OF NURSING & ALLIED HEALTH SCIENCES

ATHLETIC TRAINING PROGRAM

SELF-EVALUATION OF ATHLETIC TRAINING STUDENT

Student:
	Adhikari, Bivek	Fulton, Catherine	Johnson, Kayla	Rauschenberg, Jessica
	Blevins, Hailey	Hamilton, Kaylee	Lantz, Aaron	Self, Sydney
	Bonnewell, Reagan	Heinen, Emmalee	Massey, Brooke	Spence, Kaci
	Brown, Austin	Henricks, Colton	Nicklas, Emily	Stuart, Andrew
	Castleberry, Randa	Hill, Benjamin	Nyhan, Darolyn	Vanderwerff, Taylor
	Fischer, Jennifer	Hoffman, Tiffany	Ocenar, Andrea	Weir, Jasmine
	Floyd, Karen	Houchin, Ali	Peters, Kayla	Willcox, Devon
	Foster, Caitlin	Hudson, Taylor	Platt, Hailee	Wright, Walter

Preceptor:
	Aneshansley, Shane	Hamlin, John	Long, Travis	Rose, Susan
	Badgett, Blake	Harms, Meghan	Mahlock, Kris	Sage, David
	Blakeburn, Robert	Hart Wolfe, Chris	McCurry, Lauren	Smith, Laura
	Bolin, Kelly	Hatton, Jeremy	McKenzie, Ernest	Spencer, Breanna
	Cox, Leah	Hill, Paul	Moses, Jeff	Steinkraus, Tammy
	Crampton, Derrick	Hollandsworth, Randa	Oliver, Kalyp	Walker, Leander
	Cruse, Anthony	Holley, Dr.	Raines, Rob	Warford, Travis
	Detweiler, Edwin	Jones, Daniel	Rickey, Jody	Young, Jessica
	Foster, Dain	Kiehn, Michael	Rideau, Cesiley

Clinical Site:
	Badgett, Dr. Blake	Regeneration Physical Therapy
	Clinton High School	SWOSU Athletics
	Human Performance Center--PT	SWOSU Student Health Services
	Integris Clinton Regional Hospital	Southwest Orthopaedic & Reconstructive Specialists
	Integris Clinton Regional Hospital, Outpatient PT	Weatherford High School
	Orthopedic Associates	Yukon High School

Current semester in the program:

Start Date of Rotation (Month, Day, & Year)

End Date of Rotation (Month, Day, & Year)

Rating Scale:

5 = Excellent skills for this level. Consistently performs above expectations.

4 = Good skills for this level. Occasionally performs above expectations.

3 = Average skills for this level. Performs at minimum level of expectations.

2 = Below Average skills for this level. Occasionally performs below expectations.

1 = Poor skills for this level. Consistently performs below expectations.

No Score (No Reply) = Clinical Instructor feels unable to rate student on specific item. Do not calculate "No Scores" into average.

UNIVERSAL TRAITS / PERSONAL TRAITS

Attendance
		5	4	3	2	1	No Reply
	1. Punctual in reporting to daily assignments
	2. Hours completed were appropriate

INSTRUCTIONS: Click the button below to calculate the average rating for attendance.

Average Rating for Attendance:

Comments

Professionalism
		5	4	3	2	1	No Reply
	3. Develops/maintains profesional relationships with peers, supervisors, coaches, & athletes
	4. Professional demeanor
	5. Demonstrates professional & ethical behavior consistent with other allied health professionals & appropriate to the profession of athletic training
	6. Demonstrates effective coping skills in regards to physical & mental stress
	7. Demonstrates appropriate emotional maturity
	8. Dresses professionally & appropriately
	9. Responds appropriately & implements constructive criticism to benefit his/her educations as an athletic trainer

INSTRUCTIONS: Click the button below to calculate the average rating for professionalism.

Average Rating for Professionalism:

Comments

Communication
		5	4	3	2	1	No Reply
	10. Effective communication with ACI, AT staff, coaches, athletes
	11. Develops appropriate rapport with coaches, athletes, patients, AT staff, peers

INSTRUCTIONS: Click the button below to calculate the average rating for communication.

Average Rating for Communication:

Comments

Quality of Work
		5	4	3	2	1	No Reply
	12. Follows directions
	13. Completes task assigned
	14. Demonstrates reliability & dependability
	15. Follows policies & procedures
	16. Skillfully performs required tasks

INSTRUCTIONS: Click the button below to calculate the average rating for quality of work.

Average Rating for Quality of Work:

Comments

Initiative
		5	4	3	2	1	No Reply
	17. Demonstrates initiative to learn
	18. Demonstrates initiative in clinical setting
	19. Asks questions in timely manner
	20. Performs responsibilities in an independent fashion
	21. Organizes time effectively to achieve maximum productivity

INSTRUCTIONS: Click the button below to calculate the average rating for initiative.

Average Rating for Initiative:

Comments

Cooperative
		5	4	3	2	1	No Reply
	22. Works well with others
	23. Shows cooperation & appropriate relationships with staff
	24. Shows respect for the opinions of others.

INSTRUCTIONS: Click the button below to calculate the average rating for cooperative.

Average Rating for Cooperative:

Comments

Attitude
		5	4	3	2	1	No Reply
	25. Positive attitude
	26. Consistently demonstrates professional attitude
	27. Sets good examples for peers
	28. Demonstrates confidence in his/her own ability as an Athletic Trainer
	29. Provides proper encouragement & learning environment to peers

INSTRUCTIONS: Click the button below to calculate the average rating for attitude.

Average Rating for Attitude:

Comments

Interest
		5	4	3	2	1	No Reply
	30. Shows interest in athlete's well being
	31. Shows interest in the profession of athletic training
	32. Shows interest in learning
	33. Has put forth ALL EFFORTS to gain a valuable clinical experience

INSTRUCTIONS: Click the button below to calculate the average rating for interest.

Average Rating for Interest:

Comments

INSTRUCTIONS: Click the button below to calculate the average of all ratings.

Average Rating for All:

34. Identify your strengths (Characteristics that will enhance your ability as an Athletic Trainer. Include behavior qualities as well as work knowledge.)

35. Identify areas you need to improve on through the remainder of the clinical assignment (Suggestions for improvement will enhance your ability as an athletic trainer. Include behavior qualities as well as work knowledge. Be specific.)

36. List any goals you may have for the remainder of the clinical rotation.

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