Intern Performance Evaluation

Preceptor evaluation of intern

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* 1. Please complete the following:

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* 2. DOMAIN 1: Scientific Evidence Based Practice: Integration of scientific information and translation of research into practice 

  Performance consistently exceeds the requirement (Excellent) Performance frequently exceeds the requirement (Good) Performance meets the requirement (Satisfactory) Performance does not consistently meet the requirement (Fair) Performance does not meet the requirement (Poor) N/A: not applicable (no opportunity to evaluate)
CRDN 1.1  Select indicators of program quality and/or customer service and measure achievement of objectives.
CRDN 1.2  Evaluate research and apply evidence-based guidelines, systematic reviews and scientific literature in nutrition and dietetics practice.
CRDN 1.3  Justify programs, products, services and care using appropriate evidence or data.
CRDN 1.4  Conduct projects using appropriate research or quality improvement methods, ethical procedures and data analysis utilizing current and/or new technologies.
CRDN 1.5  Incorporate critical-thinking skills in overall practice.

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* 3. DOMAIN 2: Professional Practice Expectations: Beliefs, values, attitudes and behaviors for the professional dietitian nutritionist level of practice:

  Performance consistently exceeds the requirement (Excellent) Performance frequently exceeds the requirement (Good) Performance meets the requirement (Satisfactory) Performance does not consistently meet the requirement (Fair) Performance does not meet the requirement (Poor) N/A: not applicable (no opportunity to evaluate)
CRDN 2.1 Practice in compliance with current federal regulations and state statutes and rules, as applicable, and in accordance with accreditation standards and the Scope of Practice for the Registered Dietitian Nutritionist, Standards of Practice, Standards of Professional Performance, and Code of Ethics for the Profession of Nutrition and Dietetics.
CRDN 2.2  Demonstrate professional writing skills in preparing professional communications.
CRDN 2.3  Demonstrate active participation, teamwork and contributions in group settings.

(eg: Attends staff and other meetings at facility)
CRDN 2.4  Function as a member of interprofessional teams.
CRDN 2.5  Work collaboratively with NDTRs and/or support personnel in other disciplines. 
CRDN 2.6  Refer clients and patients to other professionals and services when needs are beyond individual scope of practice.

(ie:  Is familiar with the mission goals and objectives of the facility as to the scope of services provided to clients and makes referrals to appropriate staff or appropriate health care providers accordingly.)
CRDN 2.7  Apply change management strategies to achieve desired outcomes.
CRDN 2.8  Demonstrate negotiation skills.
CRDN 2.9  Actively contribute to nutrition and dietetics professional and community organizations.
CRDN 2.10  Demonstrate professional attributes in all areas of practice.
CRDN 2.11  Show cultural humility in interactions with colleagues, staff, clients, patients and the public.
CRDN 2.12  Implement culturally sensitive strategies to address cultural biases and differences.
CRDN 2.13  Advocate for local, state or national legislative and regulatory issues or policies impacting the nutrition and dietetics profession.

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* 4. DOMAIN 3: Clinical & Customer Services: Development and delivery of information, products, services to individuals, groups and populations:

  Performance consistently exceeds the requirement (Excellent) Performance frequently exceeds the requirement (Good) Performance meets the requirement (Satisfactory) Performance does not consistently meet the requirement (Fair) Performance does not meet the requirement (Poor) N/A: not applicable (no opportunity to evaluate)
CRDN 3.1  Perform Medical Nutrition Therapy by utilizing the Nutrition Care Process including use of standardized nutrition terminology as a part of the clinical workflow elements for individuals, groups and populations of differing ages and health status, in a variety of settings.
CRDN 3.2  Conduct nutrition focused physical assessment.
CRDN 3.3  Perform routine health screening assessments including measuring blood pressure, conducting waived point-of-care laboratory testing (such as blood glucose or cholesterol), recommending and/or initiating nutrition-related pharmacotherapy plans (such as modifications to bowel regimens, carbohydrate to insulin ratio, B12 or iron supplementation)
CRDN 3.4  Provide instruction to clients/patients for self-monitoring blood glucose, considering diabetes medication and medical nutrition therapy plan.
CRDN 3.5  Explain the steps involved and observe the placement of nasogastric or nasoenteric feeding tubes; if available, assist in the process of placing nasogastric or nasoenteric feeding tube.
CRDN 3.6  Conduct a swallow screen and refer to the appropriate health care professional for full swallow evaluation when needed.
CRDN 3.7  Demonstrate effective communication and documentation skills for clinical and client services in a variety of formats and settings, which include telehealth and other information technologies and digital media.
CRDN 3.8  Design, implement and evaluate presentations to a target audience.
CRDN 3.9  Develop nutrition education materials that are culturally and age appropriate and designed for the literacy level of the audience.
CRDN 3.10  Use effective education and counseling skills to facilitate behavior change.
CRDN 3.11  Develop and deliver products, programs or services that promote consumer health, wellness and lifestyle management.
CRDN 3.12  Deliver respectful, science-based answers to client/patient questions concerning emerging trends.
CRDN 3.13  Coordinate procurement, production, distribution and service of goods and services, demonstrating and promoting responsible use of resources.
CRDN 3.14  Develop and evaluate recipes, formulas and menus for acceptability and affordability that accommodate the cultural diversity and health needs of various populations, groups and individuals.

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* 5. DOMAIN 4: Practice Management & Use of Resources: Strategic application of principles of management and systems in the provision of services to individuals and organizations:

  Performance consistently exceeds the requirement (Excellent) Performance frequently exceeds the requirement (Good) Performance meets the requirement (Satisfactory) Performance does not consistently meet the requirement (Fair) Performance does not meet the requirement (Poor) N/A: not applicable (no opportunity to evaluate)
CRDN 4.1 Participate in management functions of human resources (such as hiring, training and scheduling).
CRDN 4.2  Perform management functions related to safety, security and sanitation that affect employees, customers, patients, facilities and food.
CRDN 4.3  Conduct clinical and customer service quality management activities (such as quality improvement or quality assurance projects).
CRDN 4.4  Apply current nutrition informatics to develop, store, retrieve and disseminate information and data.
CRDN 4.5  Analyze quality, financial and productivity data for use in planning.
CRDN 4.6  Propose and use procedures as appropriate to the practice setting to promote sustainability, reduce waste and protect the environment.
CRDN 4.7  Conduct feasibility studies for products, programs or services with consideration of costs and benefits.
CRDN 4.8  Develop a plan to provide or develop a product, program or service that includes a budget, staffing needs, equipment and supplies.
CRDN 4.9  Engage in the process for coding and billing for nutrition and dietetics services to obtain reimbursement from public or private payers, fee-for-service and value-based payment systems.
CRDN 4.10  Analyze risk in nutrition and dietetics practice (such as risks to achieving set goals and objectives, risk management plan, or risk due to clinical liability or foodborne illness). 

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* 6. DOMAIN 5: :  Leadership and Career Management: Skills, strengths, knowledge and experience relevant to leadership potential and professional growth for the nutrition and dietetics practitioner:

  Performance consistently exceeds the requirement (Excellent) Performance frequently exceeds the requirement (Good) Performance meets the requirement (Satisfactory) Performance does not consistently meet the requirement (Fair) Performance does not meet the requirement (Poor) N/A: not applicable (no opportunity to evaluate)
CRDN 5.1 Perform self-assessment that includes awareness in terms of learning and leadership styles and cultural orientation and develop goals for self-improvement.
CRDN 5.2  Identify and articulate one’s skills, strengths, knowledge and experiences relevant to the position desired and career goals.
CRDN 5.3  Prepare a plan for professional development according to Commission on Dietetic Registration guidelines.
CRDN 5.4  Advocate for opportunities in the professional settings (such as asking for additional responsibility, practicing negotiating a salary or wage or asking for a promotion).
CRDN 5.5  Demonstrate the ability to resolve conflict.
CRDN 5.6  Promote team involvement and recognize the skills of each member.
CRDN 5.7  Mentor others.
CRDN 5.8  Identify and articulate the value of precepting.

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* 7. Identify special strengths (personal characteristics, technical competence, professional practice, self-growth).

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* 8. Identify areas to be strengthened (personal characteristics, technical competence, professional practice).

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* 9. Overall Assessment of Intern:

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* 10. Overall Student Performance:  Please select the letter grade that represents the intern’s overall performance.

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* 11. Preceptor Signature

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