ASSESSMENT TOOL FOR CMD 568 ‑ AUDIOLOGY PRACTICUM

 

DEPARTMENT OF COMMUNICATION DISORDERS Southern Connecticut State University

 

Evaluation of Speech Pathology Student In Audiology

Practicum

 

Student_________               Supervisor                Date

 

 

Please rate the student's competencies in terms of the following scale by marking the most appropriate number:

 

1. Unsatisfactory.

Competency not apparent.

2. Fair.

Competency apparent but not implemented

3. Average.

Competency demonstrated 50% of the time

4. Good

Competency demonstrated 75% of the time

5. Excellent

Competency demonstrated consistently.

If you are unable to rate an item or it it is not appropriate, mark “X” for the item.

 

PROFESSIONAL RESPONSIBILTY

1. Punctuality in reporting to assignment

1

2

3

4

5

X

2. Promptness in submitting written

   materials

1

2

3

4

5

X

3. Orderliness in maintaining clinic

   facilities

1

2

3

4

5

X

4. Attendance and participation in

   group and individual supervision sessions

1

2

3

4

5

X

5. Demonstration of initiative

1

2

3

4

5

X

 

 

PROFESSIONAL INTERACTION

1. Approachability and responsiveness

   to supervisor

1

2

3

4

5

X

2. Approachability and responsiveness

  to clients

1

2

3

4

5

X

3. Respect for clients

1

2

3

4

5

X

4. Effectiveness In dealing with

   parents

1

2

3

4

5

X

5. Poise In professional Interactions

1

2

3

4

5

X

 

                                           

2

 

 

PROFESSIONAL ATTIUDES AND BEHAVIOR

1. Pride in professional role

1

2

3

4

5

X

2. Interest in clinical assignments

1

2

3

4

5

X

3. Interest in Improving performance

1

2

3

4

5

X

4. Emotional control and stability

1

2

3

4

5

X

5. Attainment of self‑evaluation skills

1

2

3

4

5

X

6. Knowledge and use of appropriate

   professional terminology at the level

   of student participation

1

2

3

4

5

X

 

 

CHECKING TEST EOUIPMENT­

1. Listening check prior to use

1

2

3

4

5

X

2. Detection of equipment problems

1

2

3

4

5

X

3. Calibration of audiometer

1

2

3

4

5

X

4. Interpretation of calibration data

1

2

3

4

5

X

 

 

 

COVENTINAL AUDIOMETRY

1. Giving instructions

1

2

3

4

5

X

2. Air conduction techniques

1

2

3

4

5

X

3. Bone conduction techniques

1

2

3

4

5

X

4. Speech audiometric techniques

1

2

3

4

5

X

5. Use of masking

1

2

3

4

5

X

6. Use of otoscope

1

2

3

4

5

X

 

 

ACOUSTIC IMMITTANCE

1. Screening techniques

1

2

3

4

5

X

2. Tympanometry

1

2

3

4

5

X

3. Contralateral acoustic reflex

1

2

3

4

5

X

4. Ipsilateral acoustic reflex

1

2

3

4

5

X

                                               

 

 

PEDIATRIC TECHNIQUES

1. Behavioral observation audiometry

1

2

3

4

5

X

2. Visual reinforcement audiometry

1

2

3

4

5

X

3. Conditioned play audiometry

1

2

3

4

5

X

4. Management of child

1

2

3

4

5

X

5. Speech audiometry techniques

1

2

3

4

5

X

                                               

                                               

3

 

AMPLIFICATON                 <Check:ADULTS     CHILDREN   >

1. Earmold impressions

1

2

3

4

5

X

2. Trouble shooting

1

2

3

4

5

X

3. Hearing aid orientation

1

2

3

4

5

X

                                               

 

 

AURAL REHABILTATION      <Check: ADULT     CHILDREN    >

1. Selection of appropriate tests

   for assessment of communication

    skills

1

2

3

4

5

X

2.  Interpretation of individual tests

1

2

3

4

5

X

3.  Interpretation of test profile

1

2

3

4

5

X

4.  Selection of appropriate referral

    sources

1

2

3

4

5

X

5.  Rehabilitative counseling at level

    of student participation

1

2

3

4

5

X

   

 

In the space below, please make any comments that are

important about the student's performance of this clinical assignment:

 

Midterm Practicum Grade

 

Final Practicum Grade