REVIEW OF PLACEMENT A
SECTION 1: DETAILS OF STUDENT AND STUDENT LEAD
Student Name:
Lead Practice Educator Name:
Location of Placement:
Placement Start Date:
Placement Finish Date:
Number of days/weeks
Completed:
SECTION 2: SUMMARY OF EVIDENCE FOR PRACTICE WEEKS
EVIDENCE
confirmation
Student
Completion of campus evidence checked
Model and process for nutrition and dietetic practice (A1; A2; A3; A4, A5; A6; A7)
Completed checklist for 3 clients/ patients
Tutor
Notes regarding observations of dietitians use of the model and process
Professionalism (A1)
Notes from discussions and tasks associated with local policy and practices
Identify nutritional needs for individuals, groups and populations (A3)
Copy of health hunt report
Understand referral/ request for assistance pathways and criteria used by dietitians to
open a duty of care and to prioritise care. (A3)
Observation of Practice tool
Notes from student led discussion
Anonymised completed MUST tools
Communication (A2)
Completed communication skills assessment tools
Report of communication with service users and professionals
Clinical practice (Care setting/nursing experience) (A1; A2; A3)
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Report on food, drink and meal provision
EVIDENCE
confirmation
Student
Tutor
Consent (A1; A2)
Notes of observations and student led discussion session.
Anthropometry (A1; A2; A3)
List of anthropometric variables to be measured in allocated client group
Summary of presentation
Reflection on communication
Biochemical, Haematological and Microbiological Assessment (A3)
Completed table
Notes from discussions
Clinical assessment (A4)
Summary of clinical data/physiological parameters for 4 patients.
Summary of medications for 4 patients
Expanded table of medications
Dietary assessment and nutritional requirements for populations and individuals (A1;
A2; A3; A4)
Copy of written feedback that you provided to your peer (appropriately
anonymised)
Details of the two patient diet histories
Brief notes of your qualitative and quantitative assessment of each patient’s
diet.
Analysis and recommendations for Service User diet history
Routes of feeding, food first, food enrichment (A5)
Notes about food first approach within a hospital environment
Ready reckoner
Notes of discussion with Practice Educator
Information gathering and documentation (A1; A2; A3; A6)
Notes of observations of consultation, answers to questions and points from
discussion at student led session.
Environmental assessment - the person centred approach (A1; A2; A3)
Agreed framework
Notes from interview
Evaluation/ feedback forms
Copy of reflection using the reflective framework
Nutritional diagnosis, identification and measurement of outcomes in individuals,
groups and populations (A4; A5; A6; A7)
Notes about observations for documenting nutritional problems
Dietetic record cards (anonomysed)
Quality improvement and service evaluation (A7)
Written summary of discussions
Multi-agency team working (A1; A2)
Notes about multi-agency working
Practice Educators should sign off the evidence when the evidence table is complete
Practice Educator Name:
2
Practice Educator Signature:
Date:
SECTION 3: SUMMARY OF ACHIEVED LEARNING OUTCOMES FOR PLACEMENT A
Please use the key below to code the student’s level of competency for each of the two
summative learning outcomes (LOs) listed in the table (A1 and A2). Please justify these fully
so that further action can be taken, where appropriate. For the non-summatively assessed LOs
(A3 – A7) please comment on student’s performance, i.e. completion of tasks and state if any
actions need to be taken.
The review will be facilitated by the Lead Practice Educator and in collaboration with the
student. By signing the declaration at the end of this form (Section 5) both parties are in
agreement that this review is an accurate record of the student’s achievements.
For A1 and A2 learning outcomes the student has demonstrated that they have:
E = exceeded expectations of competency
M = met expectations of competency
F = failed to meet competency
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At the end of Placement A, in relation to individuals, groups, populations, students with supervision are able to:
LO
Learning outcome
A1
Demonstrate consistent professional
behaviour in accordance with legal
and ethical boundaries,
requirements of HCPC and local
standards
Demonstrate appropriate verbal and
non verbal communication skills
A2
LO
Learning outcome
A3
Demonstrate knowledge and
understanding of the identification of
nutritional need and assessment
Demonstrate knowledge and
understanding of nutritional
diagnosis
Demonstrate knowledge and
understanding of planning and
implementing interventions
Demonstrate knowledge and
understanding of monitoring and
review
Demonstrate knowledge and
understanding of quality
improvement and service evaluation
processes
A4
A5
A6
A7
Code
Justification
Comments
Action Plan
Action Plan (if appropriate)
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SECTION 4: RECORD OF ATTENDANCE AND IDENTITY CHECK
Record of attendance:
Date of absence
/
Date of return to placement
/
Duration of absence (days)
1.
2.
3.
(Please continue as appropriate)
Total number of days absence =
Identity Check:
I confirm that the student has had their identity checked at the start of this placement
Please tick one box as applicable (double click to fill text box):
Matriculation card
Photo Driving licence
Other official photo ID (please give details)
Signed
Date
SECTION 5: SIGNATURES AS AN ACCURATE RECORD OF ACHIEVEMENT
By signing this paperwork both parties are in agreement that this review is an
accurate record of the student’s achievements.
Student Signature:
Lead Practice Educator
Signature:
Date:
Thank you for completing this post-placement student paperwork. Please give
a copy to the student for their portfolio and send an electronic copy to the
student’s tutor.
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