Practicum/Clinical Evaluation of Student
2015 MAERB Core Curriculum
Henderson Community College Medical Assisting Program
Name of Practicum Student Being Evaluated:
Instructions: Consider each item separately and rate each item independently of all others. Indicate in the appropriate box the student’s level of competency, if applicable, or access to the specific task.
Psychomotor & Affective Competencies
| I. Anatomy & Physiology | Competent | Needs Work | Student was able to observe | Not Available at this site |
|---|---|---|---|---|
| I.P.1. Measure and record: | ||||
| a. blood pressure | ||||
| b. temperature | ||||
| c. pulse | ||||
| d. respirations | ||||
| e. height | ||||
| f. weight | ||||
| g. length (infant) | ||||
| h. head circumference (infant) | ||||
| i. pulse oximetry | ||||
| I.P.2. Perform: | ||||
| a. electrocardiography | ||||
| b. venipuncture | ||||
| c. capillary puncture | ||||
| d. pulmonary function testing | ||||
| I.P.3. Perform patient screening using established protocols | ||||
| I.P.4. Verify the rules of medication administration: | ||||
| a. right patient | ||||
| b. right medication | ||||
| c. right dose | ||||
| d. right route | ||||
| e. right time | ||||
| f. right documentation | ||||
| I.P.5. Select proper sites for administering parenteral medication | ||||
| I.P.6. Administer oral medications | ||||
| I.P.7. Administer parenteral (excluding IV) medications | ||||
| I.P.8. Instruct and prepare a patient for a procedure or a treatment | ||||
| I.P.9. Assist provider with a patient exam | ||||
| I.P.10. Perform a quality control measure | ||||
| I.P.11. Obtain specimens and perform: | ||||
| a. CLIA waived hematology test | ||||
| b. CLIA waived chemistry test | ||||
| c. CLIA waived urinalysis | ||||
| d. CLIA waived immunology test | ||||
| e. CLIA waived microbiology test | ||||
| I.P.12. Produce up-to-date documentation of provider/professional level CPR |
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| I.P.13. Perform first aid procedures for: | ||||
| a. bleeding | ||||
| b. diabetic coma or insulin shock | ||||
| c. fractures | ||||
| d. seizures | ||||
| e. shock | ||||
| f. syncope | ||||
| I.A.1. Incorporate critical thinking skills when performing patient assessment | ||||
| I.A.2. Incorporate critical thinking skills when performing patient care | ||||
| I.A.3. Show awareness of a patient’s concerns related to the procedure being performed |
| II. Applied Mathematics | Competent | Needs Work | Student was able to observe | Not Available at this site |
|---|---|---|---|---|
| II.P.1. Calculate proper dosages of medication for administration | ||||
| II.P.2. Differentiate between normal and abnormal test results | ||||
| II.P.3. Maintain lab test results using flow sheets | ||||
| II.P.4. Document on a growth chart | ||||
| II.A.1. Reassure a patient of the accuracy of the test results |
| III. Infection Control | Competent | Needs Work | Student was able to observe | Not Available at this site |
|---|---|---|---|---|
| III.P.1. Participate in bloodborne pathogen training | ||||
| III.P.2. Select appropriate barrier/personal protective equipment (PPE) | ||||
| III.P.3. Perform handwashing | ||||
| III.P.4. Prepare items for autoclaving | ||||
| III.P.5. Perform sterilization procedures | ||||
| III.P.6. Prepare a sterile field | ||||
| III.P.7. Perform within a sterile field | ||||
| III.P.8. Perform wound care | ||||
| III.P.9. Perform dressing change | ||||
| III.P.10. Demonstrate proper disposal of biohazardous material | ||||
| a. sharps | ||||
| b. regulated wastes | ||||
| III.A.1. Recognize the implications for failure to comply with Center for Disease Control (CDC) regulations in healthcare settings |
| IV. Nutrition | Competent | Needs Work | Student was able to observe | Not Available at this site |
|---|---|---|---|---|
| IV.P.1. Instruct a patient according to patient’s special dietary needs | ||||
| IV.A.1. Show awareness of patient’s concerns regarding a dietary change |
| V. Concepts of Effective Communication | Competent | Needs Work | Student was able to observe | Not Available at this site |
|---|---|---|---|---|
| V.P.1. Use feedback techniques to obtain patient information including: | ||||
| a. reflection | ||||
| b. restatement | ||||
| c. clarification | ||||
| V.P.2. Respond to nonverbal communication | ||||
| V.P.3. Use medical terminology correctly and pronounced accurately to communicate information to providers and patients | ||||
| V.P.4. Coach patients regarding: | ||||
| a. office policies | ||||
| b. health maintenance | ||||
| c. disease prevention | ||||
| d. treatment plan | ||||
| V.P.5. Coach patients appropriately considering: | ||||
| a. cultural diversity | ||||
| b. developmental life stage | ||||
| c. communication barriers | ||||
| V.P.6. Demonstrate professional telephone techniques | ||||
| V.P.7. Document telephone messages accurately | ||||
| V.P.8. Compose professional correspondence utilizing electronic technology | ||||
| V.P.9. Develop a current list of community resources related to patients’ healthcare needs | ||||
| V.P.10. Facilitate referrals to community resources in the role of a patient navigator | ||||
| V.P.11. Report relevant information concisely and accurately | ||||
| V.A.1. Demonstrate: | ||||
| a. empathy | ||||
| b. active listening | ||||
| c. nonverbal communication | ||||
| V.A.2. Demonstrate the principles of self-boundaries | ||||
| V.A.3. Demonstrate respect for individual diversity including: | ||||
| a. gender | ||||
| b. race | ||||
| c. religion | ||||
| d. age | ||||
| e. economic status | ||||
| f. appearance | ||||
| V.A.4. Explain to a patient the rationale for performance of a procedure |
| VI. Administrative Functions | Competent | Needs Work | Student was able to observe | Not Available at this site |
|---|---|---|---|---|
| VI.P.1. Manage appointment schedule using established priorities | ||||
| VI.P.2. Schedule a patient procedure | ||||
| VI.P.3. Create a patient’s medical record | ||||
| VI.P.4. Organize a patient’s medical record | ||||
| VI.P.5. File patient medical records | ||||
| VI.P.6. Utilize an EMR | ||||
| VI.P.7. Input patient data utilizing a practice management system | ||||
| VI.P.8. Perform routine maintenance of administrative or clinical equipment | ||||
| VI.P.9. Perform an inventory with documentation | ||||
| VI.A.1. Display sensitivity when managing appointments |
| VII. Basic Practice Finances | Competent | Needs Work | Student was able to observe | Not Available at this site |
|---|---|---|---|---|
| VII.P.1. Perform accounts receivable procedures to patient accounts including posting: | ||||
| a. charges | ||||
| b. payments | ||||
| c. adjustments | ||||
| VII.P.2. Prepare a bank deposit | ||||
| VII.P.3. Obtain accurate patient billing information | ||||
| VII.P.4. Inform a patient of financial obligations for services rendered | ||||
| VII.A.1. Demonstrate professionalism when discussing patient's billing record | ||||
| VII.A.2. Display sensitivity when requesting payment for services rendered |
| VIII. Third Party Reimbursement | Competent | Needs Work | Student was able to observe | Not Available at this site |
|---|---|---|---|---|
| VIII.P.1. Interpret information on an insurance card | ||||
| VIII.P.2. Verify eligibility for services including documentation | ||||
| VIII.P.3. Obtain precertification or preauthorization including documentation | ||||
| VIII.P.4. Complete an insurance claim form | ||||
| VIII.A.1. Interact professionally with third party representatives | ||||
| VIII.A.2. Display tactful behavior when communicating with medical providers regarding third party requirements | ||||
| VIII.A.3. Show sensitivity when communicating with patients regarding third party requirements |
| IX. Procedural and Diagnostic Coding | Competent | Needs Work | Student was able to observe | Not Available at this site |
|---|---|---|---|---|
| IX.P.1. Perform procedural coding | ||||
| IX.P.2. Perform diagnostic coding | ||||
| IX.P.3. Utilize medical necessity guidelines | ||||
| IX.A.1. Utilize tactful communication skills with medical providers to ensure accurate code selection |
| X. Legal Implications | Competent | Needs Work | Student was able to observe | Not Available at this site |
|---|---|---|---|---|
| X.P.1. Locate a state’s legal scope of practice for medical assistants | ||||
| X.P.2. Apply HIPAA rules in regard to: | ||||
| a. privacy | ||||
| b. release of information | ||||
| X.P.3. Document patient care accurately in the medical record | ||||
| X.P.4. Apply the Patient’s Bill of Rights as it relates to: | ||||
| a. choice of treatment | ||||
| b. consent for treatment | ||||
| c. refusal of treatment | ||||
| X.P.5. Perform compliance reporting based on public health statutes | ||||
| X.P.6. Report an illegal activity in the healthcare setting following proper protocol | ||||
| X.P.7. Complete an incident report related to an error in patient care | ||||
| X.A.1. Demonstrate sensitivity to patient rights | ||||
| X.A.2. Protect the integrity of the medical record |
| XI. Ethical Considerations | Competent | Needs Work | Student was able to observe | Not Available at this site |
|---|---|---|---|---|
| XI.P.1. Develop a plan for separation of personal and professional ethics | ||||
| XI.P.2. Demonstrate appropriate response(s) to ethical issues | ||||
| XI.A.1. Recognize the impact personal ethics and morals have on the delivery of healthcare |
| XII. Protective Practices | Competent | Needs Work | Student was able to observe | Not Available at this site |
|---|---|---|---|---|
| XII.P.1. Comply with: | ||||
| a. safety signs | ||||
| b. symbols | ||||
| c. labels | ||||
| XII.P.2. Demonstrate proper use of: | ||||
| a. eyewash equipment | ||||
| b. fire extinguishers | ||||
| c. sharps disposal containers | ||||
| XII.P.3. Use proper body mechanics | ||||
| XII.P.5. Evaluate the work environment to identify unsafe working conditions | ||||
| XII.A.1. Recognize the physical and emotional effects on persons involved in an emergency situation | ||||
| XII.A.2. Demonstrate self-awareness in responding to an emergency situation |
Additional Comments
What type of administrative duties did the student perform? What type of administrative duties did the student observe?
What type of clinical duties did the student perform? What type of clinical duties did the student observe?
What type of oversight did the Practicum Coordinator of the medical assisting program provide for the student and the site supervisor? Were you able to contact the Practicum Coordinator with any problems? Was there regular contact?
Name of Clinical Facility/Office:
Date:
Dates of Clinical Experience
Start Date:
End Date:
Voluntary Clinical Faculty (Print Name):
Date:
Voluntary Clinical Faculty (Signature):
Date:
Supervising Henderson Community College Faculty:
Date:
