Clinical Perception
Radiologic Technology Program
Student Name:
Clinical Facility:
Rotation:
Scoring: 4 = Strongly Agree 3 = Agree 2 = Disagree 1 = Strongly Disagree
FACILITY:
4 3 2 1
1. The facility provided me with an adequate number and variety
of learning experiences.
2. I was encouraged to ask questions and received clarification on techniques,
policies, and procedures from department employees and technologists.
3. I received assistance from the department sta when it was requested.
4. I was encouraged to complete procedures independently.
5. I was supervised within JRC guidelines (direct/indirect supervision).
6. I feel more competent as a result of being at this facility.
7. I was not expected to perform procedures I had not been taught in theory.
8. This facility has a professional yet comfortable atmosphere.
9. I was not subjected to destructive criticism by department sta,
radiologists, or clinical instructor.
10. I feel that this clinical facility did everything possible to make this a positive
learning experience.
11. I would like to work at this facility.
CLINICAL INSTRUCTOR 4 3 2 1
1. Clinical Instructor adequately and clearly explained expectations.
2. Room assignments reflected areas I needed to be in and were adequate in length.
3. The Clinical Instructor was available on a regular basis.
4. The Clinical Instructor or their designee demonstrated an interest
in my learning and were willing to assist with competency check-os.
5. The Clinical Instructor and Technologist Evaluations were a reasonable
reflection of my performance.
4 3 2 1
6. A proper orientation was provided by the Clinical Instructor within
the first two weeks at the facility.
7. The Clinical Instructor responded eectively to my concerns.
8. I met with the Clinical Instructor on a regular basis to discuss progress
and concerns.
9. The Clinical Instructor spent time helping me learn at times other than
during patient exams.
Comments:
Student’s Signature: Date:
Clinical Coordinator’s Signature: Date:
Program Director’s Signature: Date:
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit