Outpatient Emphasis Competency Evaluation with learning activities
Please evaluate the intern on the competencies listed below.
Scores of 1 require remediation for successful completion of the rotation.
Rotations of no longer that 3 weeks do not require a midpoint evaluation; however the preceptor may mid-point evaluate as he or she sees fit.
Competencies not accomplished due to practice site limitations should not completed and noted in the comment section.
Email *
Date of evaluation:
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Student Name *
Practice Site *
Preceptor Name and Title/Credentials *
This evaluation is being completed by *
I testify that _____ hours were completed for this rotation. *
CRDN 1.2: Apply evidence-based guidelines, systematic reviews and scientific literature. (Learning activity: research and plan treatment strategies for appropriate evidenced based patient care)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 2.3: Demonstrate active participation , teamwork, and contributions in group settings (Learning activity: active participation during shared medical appointment or interdisciplinary patient care)
Does not meet expectations
Exceeds expectation
Clear selection
CRDN 2.8: Demonstrate negotiation skills. (Learning activity: conduct appropriate counseling during interventions with obese and diabetic clients)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 2.9: Participate in professional and community organizations. (Learning activity: attend professional meetings such as the local chapters of AND or ADA)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 2.13 Prepare a plan for professional development according to the Commission on Dietetic Registration guidelines (Learning activity: complete the CDR PDP tutorial/wizard)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 2.14 Demonstrate advocacy on local, state, or national legislative and regulatory issues or policies impacting the nutrition and dietetics profession (Learning activity: write letter to a congressperson regarding a nutrition related topic)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 2.15 Practice and/or role play mentoring and precepting others (Learning activity: role play evaluation and discussion with an inten using a staff person)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 3.3: Demonstrate effective communications skills for clinical and customer services in a variety of formats and settings (Learning activity: conduct effective nutrition education during client visits)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 3.6: Use effective education and counseling skills to facilitate behavior change. (Learning activity: conduct appropriate counseling during client interventions)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 4.9: Explain the process for coding and billing for nutrition and dietetics services to obtain reimbursement from public or private payers, fee-for-service and value-based payment systems. (Learning activity: conduct billing and coding activities for outpatient services or completion of Coding and Billing Module)
Does not meet expectations
Exceeds expectations
Clear selection
CC1: Participate in comprehensive diabetes prevention programs including planning, conducting, and evaluating education session. (Learning activity: appropriately manage client care for obesity and diabetes to prevent progression) *
Does not meet expectations
Exceeds expectations
CC2: Analyze and critique strategies employed by weight management programs which seek to prevent the development and progression of obesity in overweight individuals. (Learning activity: research appropriate evidenced based treatment strategies) *
Does not meet expectations
Exceeds expectations
CC3: Manage the nutrition care of individuals in diabetes self-management education training programs and evaluate attainment of DSMET goals. (Evaluate client knowledge attainment following education sessions) *
Does not meet expectations
Exceeds expectations
Additional Comments
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