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PROFESSIONAL DEVELOPMENT EVALUATION Site: Talking Diabetes Support Group

Completed by intern or preceptor
Intern name: Claudia Gumina Date: 7/15/2014
Please assess the interns professionalism and performance as observed in your facility. If not applicable
to the site please select NA. Comments and examples may be added at the end of each section. Use
the following rating system.

NA= Did not have the opportunity to observe
1= Beginning: Does not show or needs improvement in this behavior/attitude/skill
2= Developing: Shows some ability in this behavior/attitude/skill
3= Accomplished: Regularly demonstrates competence in this behavior/attitude/skill
4= Exemplary: Consistently excels in this behavior/attitude/skill

PROFESSIONAL BEHAVIOR/ATTITUDES. WAS THE INTERN

1. Ethical, respectful and professional in her/his work
performance including confidentiality, attendance,
timeliness, sick policy and attire?
.. NA.... 1.. 2.. 3.. 4

2. Flexible with the demands of the work environment,
supervisor and coworkers?
.. NA.... 1.. 2.. 3.. 4

3. Consistent with expected timelines and goals and
able to complete projects by deadlines?
.. NA.... 1.. 2.. 3.. 4

4. Self directed, able to work independently, and took
initiative for own learning?
.. NA.... 1.. 2.. 3.. 4

5. Open to new ideas and feedback? .. NA.... 1.. 2.. 3.. 4

6. Willing to take a leadership role to achieve desired
outcomes?
.. NA.... 1.. 2.. 3.. 4

7. Able to understand and effectively solve problems
encountered at the site.
.. NA.... 1.. 2.. 3.. 4
8. Responsible in their use of resources including
money, time, staff, food, and disposable goods.
.. NA.... 1.. 2.. 3.. 4


Comments on professional behavior and attitudes:
You were professional in your interactions with this group and with Patti. You were able to adjust your
schedule because of the cancelations and also to take a leadership role in completing the presentation
with Laura.
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COMMUNICATION SKILLS. WAS THE INTERN
9. Effective in communications with preceptors and
other professionals at the site?
.. NA.... 1.. 2.. 3.. 4

10. Effective in group presentations at this site? Were
class objectives met?
.. NA.... 1.. 2.. 3.. 4

11. An active and positive contributor to team meetings
and projects?
.. NA.... 1.. 2.. 3.. 4

12. Respectful of life experiences, cultural diversity, and
educational background in all communications?
.. NA.... 1.. 2.. 3.. 4
COMMENTS ON COMMUNICATION SKILLS:
You were respectful of the group but learned a bit about the importance of predicting their knowledge
base and making sure the activities were challenging enough. In retrospect it would have been good to
have more conversations with Patti about their background and what you planned to present. I think
your educational objectives were partially met but could have been better tailored to the group.
Admittedly this is hard to predict.

WORK QUALITY. DID THE INTERN
13. Create clear, concise, accurate and neat written
work: reports, articles, chart notes, etc?
.. NA.... 1.. 2.. 3.. 4

14. Meet expectations for professional, well researched,
and high quality work?
.. NA.... 1.. 2.. 3.. 4

15. Assess, address and (if appropriate) advocate for the
needs of the organization and/or clients appropriately
and effectively?
.. NA.... 1.. 2.. 3.. 4

Comments on work quality:
The group challenged you with some questions but in general your presentations were well received. As
usual your documented work quality is very well done and your Powerpt was excellent.
Other comments and suggestions for improvement:
You did a good job with this group. I think the challenges were knowledge related and illustrate the need
for background research on what questions might be asked - though even with careful preparation there
will always be suprises. It is probably a better group to work with after the clinical rotation.


Intern signature: _______________________________________ Date
Preceptor name (please print)
Preceptor signature: Karen Balnis Date 7/15/2014