Name:

Facility: Date:

Name of Evaluator:

Criteria for Evaluating Student Performance

Proper interpretation of criteria is necessary to insure reliability of the evaluation. Each criterion is assigned a numerical rating and is defined as follows:

4	Effectively	Student performs effectively and efficiently and is able to work in a self-directed manner
3	Moderately	Student has been performing somewhat efficiently and is able to work in a self-directed manner most of the time.
2	Inadequately	Student performs below acceptable standards and frequently needs direction and supervision to accomplish routine responsibilities Or for the Midpoint evaluation; Student has not yet adequately addressed or completed the requirements for this competency statement.
0	No Basis to Judge	Performance was not observed or experience was not available. (Not included in calculating rating points.)

Interpretation of Clinical Grade The final clinical performance grade will be determined from the average of the total rating points as follows:

Interns will be required to be rated as at least Moderately Competent in all Competency Statements (CD) on the final evaluation to successfully complete the course.
The minimum performance level for the competency is indicated by the action verb used at the beginning of the statement. The action verbs reflect four levels of performance. The higher level of performance assumes the ability to perform at the lower level:

1. Assist - independent performance under supervision, or
   Participate - take part in team activities
2. Perform - Able to initiate activities without direct supervision, or
   Conduct- Activities performed independently
3. Consult - Able to perform specialized functions that are discrete delegated activities intended to improve the work of others
4. Supervise - Able to oversee daily operation of a unit including personnel, resource utilization, and environmental issues; or coordinate and direct the activities of a team or project workgroup
5. Manage - Able to plan, organize, and direct an organization unit throughout actual or simulated experiences, including knowing what questions to ask.

If the verb "manage" is used, it assumes that the student will progress from "supervise" or "perform/do" the activity while in the program. (Note: the perform level is indicated in parenthesis at the end of the statements to which it applies.) Students may demonstrate that they can manage or supervise through such activities as quality improvement audits, systems review, or directing an activity coordinating others.

Core Competencies for Dietitians (CD) Upon completion of the supervised practice component dietitian education, all graduates will be able to do the following. Indicate the strength of which the student meets each competency:
CD 1. Perform in accordance with the Code of Ethics for the Profession of Dietetics	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 3. Participate in professional activities	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 4. Perform self - assessment, prepare a portfolio for professional development, and participate in lifelong learning activities	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 6. Use current technologies for information and communication activities (perform)	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 8. Provide dietetics education in supervised practice settings (perform)	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 10. Supervise education and training for target groups	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 13. Interpret and incorporate new scientific knowledge into practice	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 14. Supervise quality improvement, including systems and customer satisfaction for dietetics service and/or practice	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 15. Develop and measure outcomes for food and nutrition services and practice (perform)	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 16. Participate in organizational change and planning and in goal-setting processes	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 17. Participate in business or operating plan development	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 18. Supervise the collection and processing of financial data	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 19. Perform marketing functions	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 20. Participate in human resources functions	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 21. Participate in facility management, including equipment selection and design/redesign of work units	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 22. Supervise the integration of financial, human, physical, and material resources and services	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 23. Supervise production of food that meets nutrition guidelines, cost parameters, and consumer acceptance	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 24. Supervise development and/or modification of recipes/formulas	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 25. Supervise translation of nutrition into foods/menus for target populations	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 26. Supervise design of menus as indicated by the patient's client's health status	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 27. Participate in applied sensory evaluation of food and nutrition products	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 28. Supervise procurement, distribution, and service within delivery systems	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 29. Manage safety and sanitation issues related to food and nutrition	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
FS 2. Manage menu development for target populations	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
FS 3. Manage applied sensory evaluation of food and nutrition products	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
FS 5. Manage procurement, distribution, and service within delivery systems	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
BE 2. Develop business or operating plan(perform)	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge

Student's Outstanding Qualities

Knowledge and Skill Which Student Must Improve

Student's Comments