Phlebotomy Site Evaluation Tech Prep Summer 2011
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This form will be used to evaluate the quality of instruction at the clinical site you have just attended. Your input is important in evaluating the quality of experiences at your clinical site to determine placement of future students at this site.
These evaluations will be utilized in such a way that anonymity of the student is maintained. Please be as objective as possible in filling out the evaluation form. Just as you would not want to be evaluated based on the performance of one bad day please select your response on the overall quality of your rotation.
Click on the appropriate response in the radio button to the left of each question. Comments are extremely welcome, especially in those areas where you selected a negative response.
1
. Please fill in your name and HOME/PERSONAL email address.
Please fill in your name and HOME/PERSONAL email address.
Name:
Personal Email Address:
*
2
. Which high school did you attend?
Which high school did you attend?
Akins
Bastrop
Cedar Park
Del Valle
Hendrickson
Leander
McNeil
Pflugerville
Vista Ridge
*
3
. I signed up for the Phlebotomy Practicum because:
I signed up for the Phlebotomy Practicum because:
I wanted the certificate to get a job.
I wanted the certificate to help me with my future job profession.
My instructor pressured me, I felt I had no choice.
Other: please describe in the comment box.
Other (please specify)
*
4
. Please select the answer which best describes your feelings about performing the clinical rotation.
Please select the answer which best describes your feelings about performing the clinical rotation.
I have NO regrets, this was awesome!
I found it beneficial, but mixed feeling. It was just OK.
I regret my decision and wish I had not done it.
5
. What are your future plans? Check ALL that apply.
What are your future plans? Check ALL that apply.
Attend college.
Get a part time job as a phlebotomist.
Get a full time job as a phlebotomist.
Other, please indicate below.
Other (please specify)
*
6
. If you are going on to college, either now or in the future, state the degree or profession you will focus on, i.e., nursing, doctor, laboratory, etc.
If you are going on to college, either now or in the future, state the degree or profession you will focus on, i.e., nursing, doctor, laboratory, etc.
*
7
. The on-site rotation was:
The on-site rotation was:
Extremely helpful
Very helpful
Somewhat helpful
Not helpful, wish I had more time.
Please comment on your experience:
*
8
. Where did you perform your clinical rotation? Copy the name of the site from your clinical rotation schedule.
Where did you perform your clinical rotation? Copy the name of the site from your clinical rotation schedule.
*
9
. The time allotted for the off-site rotation was:
The time allotted for the off-site rotation was:
adequate
too short
too long
Please add additional comments to give us more clarity on your response if you wish.
*
10
. I was busy:
I was busy:
all of the time
most of the time
some of the time
Please add additional comments to give us more clarity on your response if you wish.
*
11
. The objectives of this rotation were:
The objectives of this rotation were:
very clear
somewhat clear
unclear
Please add additional comments to give us more clarity on your response if you wish.
*
12
. Completing my objectives was:
Completing my objectives was:
easy, due to the wide variety and number of procedures performed.
a little difficult due to the moderate variety and number of procedures performed.
difficult due to the limited variety or number of procedures performed.
Please add additional comments to give us more clarity on your response if you wish.
*
13
. I feel my knowledge and competency level upon entering the off-site rotation was:
I feel my knowledge and competency level upon entering the off-site rotation was:
excellent
good
average
weak
Please add additional comments to give us more clarity on your response if you wish.
*
14
. I feel that my knowledge and competency level upon completing the off-site rotation is:
I feel that my knowledge and competency level upon completing the off-site rotation is:
excellent
good
average
week
Please add additional comments to give us more clarity on your response if you wish.
*
15
. The clinical staff I worked with were:
The clinical staff I worked with were:
very helpful
somewhat helpful
not at all helpful
Please add additional comments to give us more clarity on your response if you wish.
*
16
. Do you believe the clinical staff you worked with were knowledgeable about the current practice of phlebotomy? If "no" please add comments.
Do you believe the clinical staff you worked with were knowledgeable about the current practice of phlebotomy? If "no" please add comments.
yes
somewhat
no, please describe in the "comments" field below.
Please add additional comments to give us more clarity on your response if you wish.
*
17
. Did the clinical staff assist in answering questions readily and encourage more?
Did the clinical staff assist in answering questions readily and encourage more?
yes
somewhat
no
Please add additional comments to give us more clarity on your response if you wish.
*
18
. If I needed help with a procedure or question clinical staff were:
If I needed help with a procedure or question clinical staff were:
always there
sometimes there
never there
Please add additional comments to give us more clarity on your response if you wish.
*
19
. The clinical staff in charge of the rotation let me know what I would be doing:
The clinical staff in charge of the rotation let me know what I would be doing:
always
occasionally
when asked
seldom
Please add additional comments to give us more clarity on your response if you wish.
*
20
. Personality conflicts with clinical staff were:
Personality conflicts with clinical staff were:
never a problem
sometimes a problem, please describe in the "comments" field below.
always a problem, please describe in the "comments" field below.
If you selected "somtimes" or "always" please provide an explanation.
*
21
. The clinical staff I worked with treated me and each other with respect:
The clinical staff I worked with treated me and each other with respect:
all of the time
most of the time
some of the time
Please add additional comments to give us more clarity on your response if you wish.
*
22
. The clinical staff I worked with created an atmosphere that encouraged me to become a phlebotomy professional:
The clinical staff I worked with created an atmosphere that encouraged me to become a phlebotomy professional:
all of the time
most of the time
some of the time
Please add additional comments to give us more clarity on your response if you wish.
*
23
. The methodology used in this rotation was consistent with the theory and practice presented in the course:
The methodology used in this rotation was consistent with the theory and practice presented in the course:
all of the time
some of the time
none of the time
If you selected "some" or "none" of the time please provide examples.
*
24
. Procedures I was expected to perform were explained:
Procedures I was expected to perform were explained:
thoroughly
briefly
not at all
Please add additional comments to give us more clarity on your response if you wish.
*
25
. Did the organization of this clinical rotation enhance learning?
Did the organization of this clinical rotation enhance learning?
yes
somewhat
needs improvement, please describe in the "comments" field below.
If you answered "needs improvement" please specify what improvements may be necessary below.
*
26
. List three items which had a positive impact and enhanced the quality of learning at this clinical site.
List three items which had a positive impact and enhanced the quality of learning at this clinical site.
1
2
3
*
27
. List three items which had a negative impact which decreased the quality of learning at this site. IMPORTANT: If you cannot think of anything negative just put N/A on each line.
List three items which had a negative impact which decreased the quality of learning at this site. IMPORTANT: If you cannot think of anything negative just put N/A on each line.
1.
2.
3.
28
. List any improvements which you feel are necessary at this clinical site. IMPORTANT: If you think it is fine put N/A. If you know of improvements be as specific as possible.
List any improvements which you feel are necessary at this clinical site. IMPORTANT: If you think it is fine put N/A. If you know of improvements be as specific as possible.
*
29
. What words of advice would you give future high school students who go through the phlebotomy program?
What words of advice would you give future high school students who go through the phlebotomy program?
*
30
. Please provide information about the training at your HIGH SCHOOL by addressing the following questions:
*Which skill(s) did you feel weakest in?
*Which skills do you believe you were strongest in?
*What improvements would you recommend to your instructor?
*Any other helpful comments to improve the training at your high school.
Please provide information about the training at your HIGH SCHOOL by addressing the following questions: *Which skill(s) did you feel weakest in? *Which skills do you believe you were strongest in? *What improvements would you recommend to your instructor? *Any other helpful comments to improve the training at your high school.
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