Clinical Faculty Self-Assessment

Question Title

* 1. Prior to the start of each affiliation, the ACCE will distribute this self-assessment tool to the clinical site. It should be completed by the clinical instructor who will be directly supervising the student. The information gathered from this document will be used to help identify appropriate topics for annual clinical faculy development activities.

PT/PTA Name:

Facility Name:

Current Position:

Job Responsibilities:

Number of years of Clinical Experience:

Number of years as CI:

Other Professional Offices Held/Committee Appointments:

Question Title

* 2. Please rate yourself in the following areas:

	No Knowledge	Weak Knowledge	Clinical Competence	Able to Teach	My Specialty
Basic Sciences	Basic Sciences No Knowledge	Basic Sciences Weak Knowledge	Basic Sciences Clinical Competence	Basic Sciences Able to Teach	Basic Sciences My Specialty
Clinical Sciences	Clinical Sciences No Knowledge	Clinical Sciences Weak Knowledge	Clinical Sciences Clinical Competence	Clinical Sciences Able to Teach	Clinical Sciences My Specialty
Measurement Techniques	Measurement Techniques No Knowledge	Measurement Techniques Weak Knowledge	Measurement Techniques Clinical Competence	Measurement Techniques Able to Teach	Measurement Techniques My Specialty
Basic Treatment Planning	Basic Treatment Planning No Knowledge	Basic Treatment Planning Weak Knowledge	Basic Treatment Planning Clinical Competence	Basic Treatment Planning Able to Teach	Basic Treatment Planning My Specialty
Pt Delivery Systems	Pt Delivery Systems No Knowledge	Pt Delivery Systems Weak Knowledge	Pt Delivery Systems Clinical Competence	Pt Delivery Systems Able to Teach	Pt Delivery Systems My Specialty
Professional Literature Review and Writing	Professional Literature Review and Writing No Knowledge	Professional Literature Review and Writing Weak Knowledge	Professional Literature Review and Writing Clinical Competence	Professional Literature Review and Writing Able to Teach	Professional Literature Review and Writing My Specialty
Professional Values	Professional Values No Knowledge	Professional Values Weak Knowledge	Professional Values Clinical Competence	Professional Values Able to Teach	Professional Values My Specialty
Government and Social Issues	Government and Social Issues No Knowledge	Government and Social Issues Weak Knowledge	Government and Social Issues Clinical Competence	Government and Social Issues Able to Teach	Government and Social Issues My Specialty
Ethics - Professional	Ethics - Professional No Knowledge	Ethics - Professional Weak Knowledge	Ethics - Professional Clinical Competence	Ethics - Professional Able to Teach	Ethics - Professional My Specialty
Ethics - Business	Ethics - Business No Knowledge	Ethics - Business Weak Knowledge	Ethics - Business Clinical Competence	Ethics - Business Able to Teach	Ethics - Business My Specialty
Legal Issues in Healthcare/PT	Legal Issues in Healthcare/PT No Knowledge	Legal Issues in Healthcare/PT Weak Knowledge	Legal Issues in Healthcare/PT Clinical Competence	Legal Issues in Healthcare/PT Able to Teach	Legal Issues in Healthcare/PT My Specialty
ADL's and Functional Assessment and Training	ADL's and Functional Assessment and Training No Knowledge	ADL's and Functional Assessment and Training Weak Knowledge	ADL's and Functional Assessment and Training Clinical Competence	ADL's and Functional Assessment and Training Able to Teach	ADL's and Functional Assessment and Training My Specialty
Balance and Gait Training	Balance and Gait Training No Knowledge	Balance and Gait Training Weak Knowledge	Balance and Gait Training Clinical Competence	Balance and Gait Training Able to Teach	Balance and Gait Training My Specialty
Biofeedback	Biofeedback No Knowledge	Biofeedback Weak Knowledge	Biofeedback Clinical Competence	Biofeedback Able to Teach	Biofeedback My Specialty
Developmental Sequence	Developmental Sequence No Knowledge	Developmental Sequence Weak Knowledge	Developmental Sequence Clinical Competence	Developmental Sequence Able to Teach	Developmental Sequence My Specialty
Electrotherapy	Electrotherapy No Knowledge	Electrotherapy Weak Knowledge	Electrotherapy Clinical Competence	Electrotherapy Able to Teach	Electrotherapy My Specialty
External Compression Units and Garments	External Compression Units and Garments No Knowledge	External Compression Units and Garments Weak Knowledge	External Compression Units and Garments Clinical Competence	External Compression Units and Garments Able to Teach	External Compression Units and Garments My Specialty
Hydrotherapy	Hydrotherapy No Knowledge	Hydrotherapy Weak Knowledge	Hydrotherapy Clinical Competence	Hydrotherapy Able to Teach	Hydrotherapy My Specialty
Aquatic Therapy	Aquatic Therapy No Knowledge	Aquatic Therapy Weak Knowledge	Aquatic Therapy Clinical Competence	Aquatic Therapy Able to Teach	Aquatic Therapy My Specialty
Orthotics	Orthotics No Knowledge	Orthotics Weak Knowledge	Orthotics Clinical Competence	Orthotics Able to Teach	Orthotics My Specialty
Prosthetics	Prosthetics No Knowledge	Prosthetics Weak Knowledge	Prosthetics Clinical Competence	Prosthetics Able to Teach	Prosthetics My Specialty
Patient/Family Education Methodologies	Patient/Family Education Methodologies No Knowledge	Patient/Family Education Methodologies Weak Knowledge	Patient/Family Education Methodologies Clinical Competence	Patient/Family Education Methodologies Able to Teach	Patient/Family Education Methodologies My Specialty
Posture and Body Mechanics	Posture and Body Mechanics No Knowledge	Posture and Body Mechanics Weak Knowledge	Posture and Body Mechanics Clinical Competence	Posture and Body Mechanics Able to Teach	Posture and Body Mechanics My Specialty
Pulmonary	Pulmonary No Knowledge	Pulmonary Weak Knowledge	Pulmonary Clinical Competence	Pulmonary Able to Teach	Pulmonary My Specialty
Basic Therapeutic Exercise	Basic Therapeutic Exercise No Knowledge	Basic Therapeutic Exercise Weak Knowledge	Basic Therapeutic Exercise Clinical Competence	Basic Therapeutic Exercise Able to Teach	Basic Therapeutic Exercise My Specialty
Isokinetics	Isokinetics No Knowledge	Isokinetics Weak Knowledge	Isokinetics Clinical Competence	Isokinetics Able to Teach	Isokinetics My Specialty
Close Chain Exercise	Close Chain Exercise No Knowledge	Close Chain Exercise Weak Knowledge	Close Chain Exercise Clinical Competence	Close Chain Exercise Able to Teach	Close Chain Exercise My Specialty
Work Hardening	Work Hardening No Knowledge	Work Hardening Weak Knowledge	Work Hardening Clinical Competence	Work Hardening Able to Teach	Work Hardening My Specialty
Ergonomics	Ergonomics No Knowledge	Ergonomics Weak Knowledge	Ergonomics Clinical Competence	Ergonomics Able to Teach	Ergonomics My Specialty
Massage	Massage No Knowledge	Massage Weak Knowledge	Massage Clinical Competence	Massage Able to Teach	Massage My Specialty
Thermal Agents (HP, US, PA, IR, Cold)	Thermal Agents (HP, US, PA, IR, Cold) No Knowledge	Thermal Agents (HP, US, PA, IR, Cold) Weak Knowledge	Thermal Agents (HP, US, PA, IR, Cold) Clinical Competence	Thermal Agents (HP, US, PA, IR, Cold) Able to Teach	Thermal Agents (HP, US, PA, IR, Cold) My Specialty
Traction	Traction No Knowledge	Traction Weak Knowledge	Traction Clinical Competence	Traction Able to Teach	Traction My Specialty
Infection Control/ Sterile Procedure	Infection Control/ Sterile Procedure No Knowledge	Infection Control/ Sterile Procedure Weak Knowledge	Infection Control/ Sterile Procedure Clinical Competence	Infection Control/ Sterile Procedure Able to Teach	Infection Control/ Sterile Procedure My Specialty
Burns and Wound Care	Burns and Wound Care No Knowledge	Burns and Wound Care Weak Knowledge	Burns and Wound Care Clinical Competence	Burns and Wound Care Able to Teach	Burns and Wound Care My Specialty
ADA incl Architectural Barriers and Modifications	ADA incl Architectural Barriers and Modifications No Knowledge	ADA incl Architectural Barriers and Modifications Weak Knowledge	ADA incl Architectural Barriers and Modifications Clinical Competence	ADA incl Architectural Barriers and Modifications Able to Teach	ADA incl Architectural Barriers and Modifications My Specialty
Functional Activities	Functional Activities No Knowledge	Functional Activities Weak Knowledge	Functional Activities Clinical Competence	Functional Activities Able to Teach	Functional Activities My Specialty
Orthopedics incl Eval, Rx, Outcomes assess	Orthopedics incl Eval, Rx, Outcomes assess No Knowledge	Orthopedics incl Eval, Rx, Outcomes assess Weak Knowledge	Orthopedics incl Eval, Rx, Outcomes assess Clinical Competence	Orthopedics incl Eval, Rx, Outcomes assess Able to Teach	Orthopedics incl Eval, Rx, Outcomes assess My Specialty
Neurotherapies incl Sensory, Equilib, Righting, Devel Reflexes, Eval and Rx	Neurotherapies incl Sensory, Equilib, Righting, Devel Reflexes, Eval and Rx No Knowledge	Neurotherapies incl Sensory, Equilib, Righting, Devel Reflexes, Eval and Rx Weak Knowledge	Neurotherapies incl Sensory, Equilib, Righting, Devel Reflexes, Eval and Rx Clinical Competence	Neurotherapies incl Sensory, Equilib, Righting, Devel Reflexes, Eval and Rx Able to Teach	Neurotherapies incl Sensory, Equilib, Righting, Devel Reflexes, Eval and Rx My Specialty
Joint Range and Function incl geniometry	Joint Range and Function incl geniometry No Knowledge	Joint Range and Function incl geniometry Weak Knowledge	Joint Range and Function incl geniometry Clinical Competence	Joint Range and Function incl geniometry Able to Teach	Joint Range and Function incl geniometry My Specialty
Muscle physiology and Function incl MMT	Muscle physiology and Function incl MMT No Knowledge	Muscle physiology and Function incl MMT Weak Knowledge	Muscle physiology and Function incl MMT Clinical Competence	Muscle physiology and Function incl MMT Able to Teach	Muscle physiology and Function incl MMT My Specialty
Basic PT skills incl Vital Signs	Basic PT skills incl Vital Signs No Knowledge	Basic PT skills incl Vital Signs Weak Knowledge	Basic PT skills incl Vital Signs Clinical Competence	Basic PT skills incl Vital Signs Able to Teach	Basic PT skills incl Vital Signs My Specialty
Documentation	Documentation No Knowledge	Documentation Weak Knowledge	Documentation Clinical Competence	Documentation Able to Teach	Documentation My Specialty
Reimbursement Regulations	Reimbursement Regulations No Knowledge	Reimbursement Regulations Weak Knowledge	Reimbursement Regulations Clinical Competence	Reimbursement Regulations Able to Teach	Reimbursement Regulations My Specialty
Psychosocial Aspects of Illness	Psychosocial Aspects of Illness No Knowledge	Psychosocial Aspects of Illness Weak Knowledge	Psychosocial Aspects of Illness Clinical Competence	Psychosocial Aspects of Illness Able to Teach	Psychosocial Aspects of Illness My Specialty
Discharge Planning	Discharge Planning No Knowledge	Discharge Planning Weak Knowledge	Discharge Planning Clinical Competence	Discharge Planning Able to Teach	Discharge Planning My Specialty
Community Resources	Community Resources No Knowledge	Community Resources Weak Knowledge	Community Resources Clinical Competence	Community Resources Able to Teach	Community Resources My Specialty
Business Communications	Business Communications No Knowledge	Business Communications Weak Knowledge	Business Communications Clinical Competence	Business Communications Able to Teach	Business Communications My Specialty
Professional Writing/ Publications	Professional Writing/ Publications No Knowledge	Professional Writing/ Publications Weak Knowledge	Professional Writing/ Publications Clinical Competence	Professional Writing/ Publications Able to Teach	Professional Writing/ Publications My Specialty
Personal Time Management	Personal Time Management No Knowledge	Personal Time Management Weak Knowledge	Personal Time Management Clinical Competence	Personal Time Management Able to Teach	Personal Time Management My Specialty
Clinical (treatment) Time Management	Clinical (treatment) Time Management No Knowledge	Clinical (treatment) Time Management Weak Knowledge	Clinical (treatment) Time Management Clinical Competence	Clinical (treatment) Time Management Able to Teach	Clinical (treatment) Time Management My Specialty
PT Administration	PT Administration No Knowledge	PT Administration Weak Knowledge	PT Administration Clinical Competence	PT Administration Able to Teach	PT Administration My Specialty
Personnel Administration	Personnel Administration No Knowledge	Personnel Administration Weak Knowledge	Personnel Administration Clinical Competence	Personnel Administration Able to Teach	Personnel Administration My Specialty
Clinical Education Organization	Clinical Education Organization No Knowledge	Clinical Education Organization Weak Knowledge	Clinical Education Organization Clinical Competence	Clinical Education Organization Able to Teach	Clinical Education Organization My Specialty
Clinical Education Teaching/Supervision	Clinical Education Teaching/Supervision No Knowledge	Clinical Education Teaching/Supervision Weak Knowledge	Clinical Education Teaching/Supervision Clinical Competence	Clinical Education Teaching/Supervision Able to Teach	Clinical Education Teaching/Supervision My Specialty
Clinical Education Evaluation	Clinical Education Evaluation No Knowledge	Clinical Education Evaluation Weak Knowledge	Clinical Education Evaluation Clinical Competence	Clinical Education Evaluation Able to Teach	Clinical Education Evaluation My Specialty
Planning of Workshops, Seminars	Planning of Workshops, Seminars No Knowledge	Planning of Workshops, Seminars Weak Knowledge	Planning of Workshops, Seminars Clinical Competence	Planning of Workshops, Seminars Able to Teach	Planning of Workshops, Seminars My Specialty
Development of Tests and Evaluation Materials	Development of Tests and Evaluation Materials No Knowledge	Development of Tests and Evaluation Materials Weak Knowledge	Development of Tests and Evaluation Materials Clinical Competence	Development of Tests and Evaluation Materials Able to Teach	Development of Tests and Evaluation Materials My Specialty
Curriculum Development	Curriculum Development No Knowledge	Curriculum Development Weak Knowledge	Curriculum Development Clinical Competence	Curriculum Development Able to Teach	Curriculum Development My Specialty
Course Design incl Educational Objectives	Course Design incl Educational Objectives No Knowledge	Course Design incl Educational Objectives Weak Knowledge	Course Design incl Educational Objectives Clinical Competence	Course Design incl Educational Objectives Able to Teach	Course Design incl Educational Objectives My Specialty
Research Methodologies	Research Methodologies No Knowledge	Research Methodologies Weak Knowledge	Research Methodologies Clinical Competence	Research Methodologies Able to Teach	Research Methodologies My Specialty
Grant Writing	Grant Writing No Knowledge	Grant Writing Weak Knowledge	Grant Writing Clinical Competence	Grant Writing Able to Teach	Grant Writing My Specialty
Communication and Group Dynamics	Communication and Group Dynamics No Knowledge	Communication and Group Dynamics Weak Knowledge	Communication and Group Dynamics Clinical Competence	Communication and Group Dynamics Able to Teach	Communication and Group Dynamics My Specialty
Leadership	Leadership No Knowledge	Leadership Weak Knowledge	Leadership Clinical Competence	Leadership Able to Teach	Leadership My Specialty
Advisement	Advisement No Knowledge	Advisement Weak Knowledge	Advisement Clinical Competence	Advisement Able to Teach	Advisement My Specialty
Instructional Methodologies	Instructional Methodologies No Knowledge	Instructional Methodologies Weak Knowledge	Instructional Methodologies Clinical Competence	Instructional Methodologies Able to Teach	Instructional Methodologies My Specialty
Instructional Materials Development	Instructional Materials Development No Knowledge	Instructional Materials Development Weak Knowledge	Instructional Materials Development Clinical Competence	Instructional Materials Development Able to Teach	Instructional Materials Development My Specialty
Computer Literacy	Computer Literacy No Knowledge	Computer Literacy Weak Knowledge	Computer Literacy Clinical Competence	Computer Literacy Able to Teach	Computer Literacy My Specialty
Computer Assisted Instruction	Computer Assisted Instruction No Knowledge	Computer Assisted Instruction Weak Knowledge	Computer Assisted Instruction Clinical Competence	Computer Assisted Instruction Able to Teach	Computer Assisted Instruction My Specialty
Learning Styles	Learning Styles No Knowledge	Learning Styles Weak Knowledge	Learning Styles Clinical Competence	Learning Styles Able to Teach	Learning Styles My Specialty

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* 3. Among those areas marked at 4 to 5, what do you wish to concentrate your efforts on most this year? Prioritize one to three.

Comments:

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* 4. Among those areas marked 3, what areas do you wish to develop this year? Prioritize one through four.

Comments:

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* 5. Among those areas marked 1 or 2, do you feel your assigned duties suffer from your lack of knowledge? If so what areas are most critical to increase your knowledge?

Comments:

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* 6. Where do you want to be professionally in five years?

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* 7. What types of professional development activities do you learn best from?

Attendance at continuing education seminars and workshops

Reading professional books, journals, and newsletters

Attendance at professional conferences, meetings and in services

Presentation at professional meetings, seminars or workshops

Keeping informed on professional issues and trends

Clinical practice and clinical observations

Watching professional videos or listening to audiocassettes

Tutoring and mentoring activities with other professionals

Computer assisted instruction

Publication of articles or books

Development of instructional or computer software materials

Service towards institution or profession

Development of courses or seminars

Completion of advanced academic work

Other

Clinical Faculty Self-Assessment

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* 2. Please rate yourself in the following areas:

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* 3. Among those areas marked at 4 to 5, what do you wish to concentrate your efforts on most this year? Prioritize one to three.

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* 4. Among those areas marked 3, what areas do you wish to develop this year? Prioritize one through four.

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* 5. Among those areas marked 1 or 2, do you feel your assigned duties suffer from your lack of knowledge? If so what areas are most critical to increase your knowledge?

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* 6. Where do you want to be professionally in five years?

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* 7. What types of professional development activities do you learn best from?

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* 8. What professional journals subscriptions do you feel would enhance your professional development?

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* 9. List your professional development objectives/activities for the next twelve months.