To be completed by the field experience preceptor and emailed,
mailed or faxed to:
Mary Dean Coleman-Kelly, PhD, RD
Department of Nutritional Sciences
Pennsylvania State University
110 Chandlee Laboratory
University Park, PA 16652
FAX: 814-863- 6103
Email: mdc15@psu.edu
Note to Preceptors: This form should be completed as though you were
evaluating a new employee. Constructive feedback and open discussion of
strengths and weaknesses are essential to the students professional growth.
You should plan to review your evaluation with the student upon completion of
it. Please remember that you and the student are required to sign the form.
Students Name:___Emily Kohler_________________________
Dates of Field Experience: _5/18/15_________ to_____7/15/15________
Check one: ____ Mid-point evaluation
_X__ Final Evaluation
Preceptors Name: __Molly Fallon, RD________ Date of Evaluation Meeting:
__7/15/15____
Intern Performance Score:
Note if Not Applicable
Po
or
Below
Averag
e
Oral
Written
Presentation Skills
Listening
Completes individual
assignments on time
Asks appropriate questions
Seeks assistance when
Average
Goo
d
Excell
ent
1.Communication Skills
2. Applies academic
preparation to tasks/projects
3. Ability to Work Independently
appropriate
Organizes and analyzes
information effectively
Identifies and solves
problems as they arise
5
5
4. Ability to Work as a Member of a Team
Can function professionally
within groups
Can communicate and
listen to ideas of others
Completes assigned group
tasks
Values ideas and
contributions of others
Willingness to undertake
new tasks
Takes on challenges and
opportunities
Desire to learn
Displayed professional
demeanor
Reported to work on time
Completed tasks in a
timely manner
Dressed neatly and
appropriately
Accepted direction and
feedback
5. Initiative
6. Professionalism
7. Overall satisfaction with
student
8. If you ranked the student as average, below average or poor for any of the
characteristics listed above, please explain why.
9. Did the student fully complete the agreed upon hour requirement?
__X__Yes ____No:
If no, please explain:
ADDITIONAL FEEDBACK:
What tasks or responsibilities was this student capable of completing
exceptionally well? What skills were very strong?
Emily has worked with multiple RD preceptors during her time at
NBI:
Emily did well with me. She observed several renal transplant evaluations and
then her final day with me she was able to conduct the interview and did well
with the diet education. She reviewed the dialysis diet and pre dialysis diet on
her own and knew the basics very well. She also taught the DM section of a pre
heart transplant nutrition education class. She came well prepared. She
engaged the audience asking them several questions and she was also able to
answer most of the questions thoroughly. She was prepared, calm, spoke clearly
and confidently. She is very pleasant, easy going, asks appropriate questions,
friendly, and fit in well with the team. Beth Coplan, RD Renal and Heart
Transplant Dietitian
Emily has been very insightful during our time in the out-patient pediatric clinic. She
has helped document detailed patient assessments. Her suggestions for goals to include
in the nutrition action plan were appropriate and sound. Emily has also displayed
confidence when making suggestions to our families during a counseling session. Emily
had the opportunity to work in a variety of Dietetic areas during the summer and it was a
pleasure to have her. Kerri Likakis, RD KidsFit Community Dietitian
Emily at times was pulled into situations with no briefing and asked to call on her
educational background to teach a Summer Nutrition class or instruct a group on recipe
substitutions. She was even asked to prepare a Quinoa Salad to be served in class when
new grains were introduced to our CHF patient population. Each time she was
improvising based on my instructions. Each time she was flexible, willing and quick
thinking with her improv. Additionally, my patient population included challenged
populations such as Adult Behavioral Health patients and adolescent special needs
children at off-site locations. She was always respectful of the patients, responsive to her
assignments and clearly showed her enjoyment of her time with patients and staff here
at NBIMC. Karen Basedow, MS, RD Outpatient Dietitian
And finally, I have to agree with the above sentiments. Emily was a
pleasure to work with this summer. She really embraced the
flexibility necessary for a community dietitian from my perspective.
No day is the same and last minute meetings/classes and schedule
changes are common. Emily thrived in this ever changing
environment; she is a quick learner and will be successful in
whatever area of dietetics she chooses to enter.
What skills does this student need to acquire? What additional courses or
experience would you recommend for this students continued development?
Again, Emilys senior year course work in medical nutrition therapy
and nutrition counseling techniques will help to hone her skills. Her
inpatient clinical exposure was limited due to the nature of our roles
here, so more experience in the inpatient setting during her
internship will help her to learn where she best fits within the field.
Students Signature:
____________________________________Date:___7/15/15________
Preceptors Signature: _________________________________Date:
___7/15/15________
I have reviewed the Weekly Journal _________. (Initial)
Final comments:
