Information in this survey is to be shared between the student and the clinical instructor(s) at midterm evaluations. Information in this survey is confidential and will not be shared by the academic program with other students.

Question Title

* 1. Assessment of Clinical Instruction

Please rate how clinical instruction was provided during this clinical experience at midterm evaluation.

  Strongly Disagree Disagree Neutral Agree Strongly Agree
The clinical instructor (CI) was familiar with the academic program's objectives and expectations for this experience.
The clinical education site had written objectives for this learning experience.
The clinical education site's objectives for this learning experience were clearly communicated.
There was an opportunity for student input into the objectives for this learning experience.
The CI provided constructive feedback on student performance.
The CI provided timely feedback on student performance.
The CI demonstrated skill in active listening.
The CI provided clear and concise communication.
The CI communicated in an open and non-threatening manner.
The CI taught in an interactive manner that encouraged problem solving.
There was a clear understanding to whom you were directly responsible and accountable.
The supervising CI was accessible when needed.
The CI clearly explained your student responsibilities.
The CI provided responsibilities that were within your scope of knowledge and skills.
The CI facilitated patient-therapist and therapist-student relationships.
Time was available with the CI to discuss patient/client management.
The CI served as a positive role model in physical therapy practice.
The CI skillfully used the clinical environment for planned and unplanned learning experiences.
The CI integrated knowledge of various learning styles into student clinical teaching.
The CI made the formal evaluation process constructive.
The CI encouraged the student to self-assess.

Question Title

* 2. Was your CI'(s) midterm evaluation of your level of performance in agreement with your self-assessment?

Question Title

* 3. If there were inconsistencies, how were they discussed and managed?

Question Title

* 4. What has your CI(s) done well to contribute to your learning?

Question Title

* 5. What, if anything, could your CI(s) and/or other staff do differently to contribute to your learning?

T