1. Instructions for Completing the Block 3 Clinical Evaluation Form

2. The Columns
No need to self-evaluate using the column section of the form
Your OB, Peds and Med/Surg clinical instructors will use this area to evaluate you in each area/core competency

4. Narrative Self-Evaluation
Students will use the narrative note section (p. 4-7)
Please be sure to locate and use the appropriate page for your current rotation….Peds, OB or Med/Surg will be at the top of the page

5. Narrative Self-Evaluation
You must evaluate yourself using three specific core competencies
The three core competencies that must be addressed are:
1) Critical thinking
2) Safe practice
3) Role development

7. Your Narrative Notes Your narrative notes must be typed; no exceptions
Ensure your narrative self-evaluations are thorough and detailed. Brief one or two sentence responses are not acceptable. You will be asked to re-do your self-eval
Do not limit yourself to only one example of how you met a particular core competency
Remember you are outlining to your clinical instructor that you met the required core competencies during that particular clinical rotation. Your self-evaluation should clearly demonstrate this

8. A Word of Caution…..
Your clinical evaluation form will be collected at the end of the semester and becomes a mandatory part of your file at MCC. As such, please keep it in good shape. No coffee spills, ripped pages, frayed corners please!
Ensure that all your instructors have documented their evaluations and signed the document. You must also sign the form before turning it in
The fully completed form will be collected during the final exam; please do not lose it as it is “your ticket in the door”
If you do lose or misplace your evaluation form, you will be required to contact each clinical instructor and get the form re-done. Please be careful with it. Thank you.