Trinity Washington University

Occupational Therapy Assistant Program

 

Student Evaluation of Fieldwork Experience – Level 1

 

The Student Evaluation of Fieldwork Experience is an important tool for the fieldwork educator, university faculty and other students. This evaluation provides information vital to each program.  Information from the student is one method utilized in evaluating the effectiveness of academic preparation as well as the value of the fieldwork learning experience.

 

Student’s Name:________________________________________________________________

 

Name of Facility:_______________________________________________________________

 

Facility Address:________________________________________________________________

 

Name/Credentials of Supervisor:___________________________________________________

 

Supervisor’s Years of Experience:_________

 

Level 1 Rotation: Physical Rehab ________  Behavioral Health ________ Pediatrics ________

 

Type of Setting: Outpatient ____ Inpatient Rehab _____ Hospital _____ School System _______

 

Supervision

  5 4 3 2 1
Supervisor provided adequate orientation          
Supervisor effectively provided positive reinforcement          
Supervisor effectively provided constructive feedback          
Supervisor provided opportunities to review and discuss client/patient information          
Supervisor provided opportunities to discuss the clinical reasoning behind OT process          

 

How were you oriented to the Level I student responsibilities?

 

 

 

Describe the level of interaction with your supervisor. Was this adequate to meet your learning needs?

Describe the opportunities you had to observe or participate in Include examples as appropriate:

    1. patient/client interview (tools used)
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    1. chart review
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    1. assessment of patient/client performance in an area of occupation (ADL, IADL, leisure, education, work)?
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    1. assessment of patient/client performance skills (MMT, sensory, cognitive, developmental, etc.)
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    1. interventions related to development of preparatory techniques (strength, ROM, cognitive training, coping skills, etc)?
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    1. occupational based interventions (ADLs, IADLs, functional mobility, work, etc.)?
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    1. documentation?  After reviewing the Level I course objectives, choose two objectives that were met and provide an example. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Student Signature                                                                   Date
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