The University of Melbourne Audiology Student Clinical Placement Assessment Form This assessment form is for student personal feedback and internal university purposes only. It is not to be copied and sent on to other people including prospective employers. PLEASE NOTE: THIS DOCUMENT WILL BE COPIED AND PASSED ON TO THE STUDENT Student’s name: Clinical Supervisor(s): Site/Clinic: Date/s of placement: Brief summary of caseload / casemix (please check boxes and/or make notes) Type of Testing Degree of Difficulty Paediatric Adult Average / easy BOA PTA High degree of difficulty case/s VRA / VROA Normal Hearing NESB patient / family Play audiometry SNHL Work with interpreter PTA (paed) Conductive hearing loss Challenging behaviours Conductive hearing loss Mixed loss Complex testing / masking SNHL Complex case e.g. NOHL Complex / ambiguous results Complex case/s e.g. autism Adult electrophysiology Infant electrophysiology Other (please specify) Amplification Counselling N/A N/A Practical / technical activities Informational Patient interaction / habilitation Personal adjustment For boxes, double click on check box to open the field options window and select checked / not checked Notes / Comments For the categories of professional conduct, interpersonal interactions, clinical assessment skills and amplification, please comment on the student’s strengths and weaknesses. The examples given for each category are not exhaustive and/or may not apply in all clinics. For each category, please comment on the student’s overall level of independence in their practice by indicating X on the line representing the Novice Intermediate Beginner Independent continuum – – according to the overall degree of supervision and guidance they required. Click and type X anywhere on the line, e.g. Novice: Intermediate beginner: Independent: Needs constant supervision Some support needed Minimal supervision and significant guidance in routine cases in routine cases If completing the form electronically please delete extra lines in each section as required. Professional conduct
The University of Melbourne Audiology Student Clinical Placement Assessment Form This assessment form is for student personal feedback and internal university purposes only. It is not to be copied and sent on to other people including prospective employers. PLEASE NOTE: THIS DOCUMENT WILL BE COPIED AND PASSED ON TO THE STUDENT Student’s name: Clinical Supervisor(s): Site/Clinic: Date/s of placement: Brief summary of caseload / casemix (please check boxes and/or make notes) Type of Testing Degree of Difficulty Paediatric Adult Average / easy BOA PTA High degree of difficulty case/s VRA / VROA Normal Hearing NESB patient / family Play audiometry SNHL Work with interpreter PTA (paed) Conductive hearing loss Challenging behaviours Conductive hearing loss Mixed loss Complex testing / masking SNHL Complex case e.g. NOHL Complex / ambiguous results Complex case/s e.g. autism Adult electrophysiology Infant electrophysiology Other (please specify) Amplification Counselling N/A N/A Practical / technical activities Informational Patient interaction / habilitation Personal adjustment For boxes, double click on check box to open the field options window and select checked / not checked Notes / Comments For the categories of professional conduct, interpersonal interactions, clinical assessment skills and amplification, please comment on the student’s strengths and weaknesses. The examples given for each category are not exhaustive and/or may not apply in all clinics. For each category, please comment on the student’s overall level of independence in their practice by indicating X on the line representing the Novice – Intermediate Beginner – Independent continuum according to the overall degree of supervision and guidance they required. Click and type X anywhere on the line, e.g. Novice: Intermediate beginner: Independent: Needs constant supervision Some support needed Minimal supervision and significant guidance in routine cases in routine cases If completing the form electronically please delete extra lines in each section as required. Professional conduct