Spreadsheet: 1f9219e7-444b-4eb8-a043-5795d380d4f7
Sheet: Sheet1

Unnamed: 0 | Hearing Clinic at SUNY Geneseo | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Unnamed: 24 | Unnamed: 25 | Unnamed: 26 | Unnamed: 27 | Unnamed: 28 | Unnamed: 29 | Unnamed: 30 | Unnamed: 31 | Unnamed: 32 | Unnamed: 33 | Unnamed: 34 | Unnamed: 35 | Unnamed: 36 | Unnamed: 37 | Unnamed: 38 | Unnamed: 39 | Unnamed: 40
 | Clinical Evaluation Form for CDSc 337: Applied Skills in Audiology
 | Student's Name:
 | Supervisor's Name:
 | Mid-Semester Rating: |  |  |  |  | Date: |  | Final Rating: |  | Date:
 | (Rating: S=Satisfactory, U=Unsatisfactory) |  |  |  |  |  |  | (Rating: S=Satisfactory, U=Unsatisfactory)
 | I. | Preparation for Clinical Sessions |  |  |  |  |  |  |  | Sufficient | Developing | Insufficient | Not Applicable |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | client | GRADE
 |  | A. | Ability to set up audiometric equipment prior to each clinical session. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Adult | S
 |  | B. | Ability to conduct a basic listening check of the audiometer. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Child | U
 |  | C. | Ability to organize materials prior to each clinical session.
 |  | D. | Ability to review, understand and integrate information available from previous evaluations (e.g., audiological, medical, speech-language, educational etc), including background information and test results.
 |  | E. | Ability to modify the test environment relative to factors associated with access, safety, distractibility, etc.
 | Skill Area Rating:
 | COMMENTS:
 | II. | Counseling |  |  |  |  |  |  |  | Sufficient | Developing | Insufficient | Not Applicable
 |  | A. | Ability to assist in conducting a case history interview.
 |  | B. | Ability to explain test results and provide information.
 |  | C. | Ability to listen and demonstrate empathy toward client and family.
 | Skill Area Rating:
 | COMMENTS:
 | III. | Administration of Audiologic Tests/Procedures |  |  |  |  |  |  |  | Sufficient | Developing | Insufficient | Not Observed
 |  | A. | Ability to give clear, concise directions, and to reinstruct and/or modify directions as needed.
 |  | B. | Ability to conduct an otoscopic examination.
 |  | C. | Ability to conduct acoustic immittance testing.
 |  | D. | Ability to conduct pure tone hearing screenings.
 |  | E. | Ability to conduct pure tone air conduction threshold testing.
 |  | F. | Ability to conduct pure tone bone conduction threshold testing.
 |  | G. | Ability to conduct Visual Reinforcement Audiometry.
 |  | H. | Ability to conduct Speech [NAME] testing.
 |  | I. | Ability to conduct word recognition testing.
 |  | J. | Ability to administer specialized tests (OAE, CAPD).
 |  | K. | Ability to adapt assessment protocol and materials when necessary.
 | Skill Area Rating:
 | COMMENTS:
 | IV. | Guided Interpretation of Audiologic Tests/Procedures |  |  |  |  |  |  |  | Sufficient | Developing | Insufficient | Not Applicable
 |  | A. | Ability to interpret otoscopic findings.
 |  | B. | Ability to interpret acoustic immittance results.
 |  | C. | Ability to interpret pure tone hearing screening results.
 |  | D. | Ability to interpret pure tone air conduction threshold results.
 |  | E. | Ability to interpret pure tone bone conduction threshold results.
 |  | F. | Ability to interpret Visual Reinforcement Audiometry results.
 |  | G. | Ability to interpret Speech Recognition Threshold results.
 |  | H. | Ability to interpret word recognition results.
 |  | I. | Ability to assist with the interpretation of results of specialized tests (OAE, CAPD).
 | Skill Area Rating:
 | COMMENTS:
 | V. | Behavioral Management |  |  |  |  |  |  |  | Sufficient | Developing | Insufficient | Not Applicable
 |  | A. | Ability to set and enforce limits/expectations in response to the level of client motivation or resistance.
 |  | B. | Ability to minimize distractions - test room, equipment, and materials arrangement.
 |  | C. | Ability to use effective reinforcement schedules.
 |  | D. | Ability to deal with client motivation or resistance.
 | Skill Area Rating:
 | COMMENTS:
 | VI. | Personal and Professional |  |  |  |  |  |  |  | Sufficient | Developing | Insufficient | Not Applicable
 |  | A. | Ability to build rapport with client and family.
 |  | B. | Ability to provide a good visual/auditory model when interacting with clients (e.g., use of Clear Speech, communication strategies).
 |  | C. | Ability to communicate commensurate with client's skills.
 |  | D. | Ability to keep appointments and begin sessions on time.
 |  | E. | Ability to manage time.
 |  | F. | Ability to conduct clinical activities with a positive attitude.
 |  | G. | Ability to respond to supervisory evaluations in an open, non-defensive manner.
 |  | H. | Ability to reflect on their recent clinical performance and accurately self-evaluate.
 |  | I. | Ability to implement supervisor's recommendations in future sessions.
 |  | J. | Ability to demonstrate independence and self-confidence in clinical skills.
 |  | K | Ability to demonstrate good organizational skills.
 |  | L. | Ability to effectively communicate audiologic results to supervisor.
 |  | M. | Ability to adhere to the ASHA Code of Ethics.
 |  | N. | Ability to maintain client confidentiality.
 |  | O. | Ability to present oneself in a professional manner (e.g., attitude, conduct, dress, prompt notification of supervisor when unable to attend a session).
 |  | P. | Ability to maintain an accurate log of clinical practicum hours.
 | Skill Area Rating:
 | COMMENTS:
 | We have discussed the information contained within this document on |  |  |  |  |  |  |  |  |  | .
 | __________________________________________             ___________________________________________
 | Student Signature |  |  |  |  |  |  | Clinical Supervisor Signature
 |  |  |  |  |  |  |  |  |  |  |  | Rev. 07/09