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..0	Effectively	Student performs effectively and efficiently and is able to work in a self-directed manner.
3.0	Moderately	Student has been performing somewhat efficiently and is able to work in a self-directed manner most of the time.
2.0	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 2. Refer clients/patients to other dietetics professionals or disciplines when a situation is beyond one's level of competence (perform)	-- 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 7. Supervise documentation of nutrition assessment and interventions	-- 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 9. Supervise counseling, education, and/or other interventions in health promotion/disease prevention for patients/clients needing medical nutrition therapy for uncomplicated instances of common conditions, e.g. hypertension, obesity, diabetes, and diverticular disease	-- 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 11. Develop and review educational materials for target populations (perform)	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 12. Participate in the use of mass media to promote food and nutrition	-- 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 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 29. Manage safety and sanitation issues related to food and nutrition	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 30. Supervise nutrition screening of individual patients/clients	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 31. Supervise nutrition assessment of individual patients/ clients with uncomplicated instances of common medical conditions, eg hypertension, obesity, diabetes, diverticular disease	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 32. Assess nutritional status of individual patients/clients with complex medical conditions, e.g., renal disease, multisystem disease, organ failure, and trauma	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 33. Design and implement nutrition care plans as indicated by the patients/clients health status (perform)	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 34. Manage monitoring of patients/clients food and/or nutrient intake	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 35. Select, implement, and evaluate standard enteral & parenteral nutrition regimens, ie, in a medically stable patient to meet nutritional requirements where recommendations/adjustments involve primarily macronutrients (perform)	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 36. Develop and implement transitional feeding plans, ie conversion from one form of nutrition support to another, eg total parenteral nutrition to tube feeding to oral diet (perform)	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 37. Coordinate and modify nutrition care activities among caregivers (perform)	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 38. Conduct nutrition care component of interdisciplinary team conferences to discuss patient/client treatment and discharge planning	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 39. Refer patients/clients to appropriate community services for general health and nutrition needs and to other primary care providers as appropriate (perform)	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 42. Provide nutrition care for people of diverse cultures and religions across the lifespan, i.e., infancy through geriatrics (perform)	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
CD 46. Participate in coding and billing of dietetics/nutrition services to obtain reimbursement for services from public or private insurers.	-- Select rating -- 4 - Effectively 3 - Moderately 2 - Inadequately 0 - No Basis to Judge
NT 2. Integrate pathophysiology into medical nutrition therapy recommendations (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