Name:

Facility: Date:

Name of Evaluator:

Criteria for Evaluating Student Performance

Proper interpretation of criteria is necessary to insure reliability of the evaluation. Each criterion is assigned a numerical rating and is defined as follows:

4	Effectively	Student performs effectively and efficiently and is able to work in a self-directed manner.
3	Moderately	Student has been performing somewhat efficiently and is able to work in a self-directed manner most of the time.
2	Inadequately	Student performs below acceptable standards and frequently needs direction and supervision to accomplish routine responsibilities Or for the Midpoint Evaluation; Student has not yet adequately addressed or completed the requirements for this competency statement.
0	No Basis to Judge	Performance was not observed or experience was not available. (Not included in calculating rating points.)

Interpretation of Clinical Grade The final clinical performance grade will be determined from the average of the total rating points as follows:

Note: Students will be required to be rated as at least moderately competent in all Competencies / Learning Objectives on the final evaluation to successfully complete the course.

The following Competencies or / Learning Outcomes are divided into fours areas:

1: Scientific and Evidence Base of Practice: integration of scientific information and research into practice

2: Professional Practice Expectations: beliefs, values, attitudes and behaviors for the professional dietitian level of practice.

3: Clinical and Customer Services: development and delivery of information, products and services to individuals, groups and populations

4: Practice Management and Use of Resources: strategic application of principles of management and systems in the provision of services to individuals and organizations

Competencies / Learning Outcomes Please indicate if - "Upon completion of the supervised practice program, graduates are able to: Indicate the strength of which the student meets each competency:
DI 1.1: Select appropriate indicators and measure achievement of clinical, programmatic, quality, productivity, economic or other outcomes	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 1.2: Apply evidence-based guidelines, systematic reviews and scientific literature (such as the ADA Evidence Analysis Library, Cochrane Database of Systematic Reviews and the U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, National Guideline Clearinghouse Web sites) in the nutrition care process and model and other areas of dietetics practice	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 1.3: Justify programs, products, services and care using appropriate evidence or data	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 1.4: Evaluate emerging research for application in dietetics practice	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 1.5: Conduct research projects using appropriate research methods, ethical procedures and statistical analysis	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 2.1: Practice in compliance with current federal regulations and state statutes and rules, as applicable and in accordance with accreditation standards and the ADA Scope of Dietetics Practice Framework, Standards of Professional Performance and Code of Ethics for the Profession of Dietetics	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 2.2: Demonstrate professional writing skills in preparing professional communications (e.g. research manuscripts, project proposals, education materials, policies and procedures)	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 2.3: Design, implement and evaluate presentations considering life experiences, cultural diversity and educational background of the target audience	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 2.4: Use effective education and counseling skills to facilitate behavior change	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 2.10: Serve in professional and community organizations	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 2.11: Establish collaborative relationships with internal and external stakeholders, including patients, clients, care givers, physicians, nurses and other health professionals, administrative and support personnel to facilitate individual and organizational goals	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 2.12: Demonstrate professional attributes such as advocacy, customer focus, risk taking, critical thinking, flexibility, time management, work prioritization and work ethic within various organizational cultures	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 2.13: Perform self assessment, develop goals and objectives and prepare a draft portfolio for professional development as defined by the Commission on Dietetics Registration	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 2.14: Demonstrate assertiveness and negotiation skills while respecting life experiences, cultural diversity and educational background	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 3.2: Develop and demonstrate effective communications skills using oral, print, visual, electronic and mass media methods for maximizing client education, employee training and marketing	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 3.3: Demonstrate and promote responsible use of resources including employees, money, time, water, energy, food and disposable goods	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 3.4: Develop and deliver products, programs or services that promote consumer health, wellness and lifestyle management merging consumer desire for taste, convenience and economy with nutrition, food safety and health messages and interventions	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 3.5: Deliver respectful, science-based answers to consumer questions concerning emerging trends	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 3.7: Develop and evaluate recipes, formulas and menus for acceptability and affordability that accommodate the cultural diversity and health needs of various populations, groups and individuals	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 4.4: Participate in public policy activities, including both legislative and regulatory initiatives	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 4.6: Use current informatics technology to develop, store, retrieve and disseminate information and data	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 4.8: Conduct feasibility studies for products, programs or services with consideration of costs and benefits	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 4.9: Obtain and analyze financial data to assess budget controls and maximize fiscal outcomes	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 4.10: Develop a business plan for a product, program or service including development of a budget, staffing needs, facility requirements, equipment and supplies	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
DI 4.11: Complete documentation that follows professional guidelines, guidelines required by health care systems and guidelines required by the practice setting	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
HP/W 1. Demonstrate the ability to obtain nutrition surveillance data for the community	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
HP/W 2. Develop health promotion / wellness nutrition programs	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
HP/W 3. Conduct health promotion / wellness nutrition program outcome assessment/evaluation	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
HP/W 4. Manage nutrition care for diverse population groups across the lifespan	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge

Student's Outstanding Qualities

Knowledge and Skill Which Student Must Improve

Student's Comments