Q1.

Dietetic Intern Evaluation: Nutrition Therapy

To better align our evaluation with the "Career Development Guide" from the Academy of Nutrition and
Dietetics, the Ball State Dietetic Internship has adjusted the terminology that is used. Please note the
following:
Definition of Performance Standards:
1. Proficient: Demonstrates additional knowledge, skills, and experience in a focus area of dietetics
practice; above entry-level practice
2. Competent*: Demonstrates sound knowledge, confidence, and effective use of entry level skills;
seeks assistance after investigating potential solutions
3. Beginner: Requires supportive or directive cues occasionally; applies principles accurately with
occasional cues; works at acceptable standards
4. Novice: Requires frequent supportive and occasional directive cues: identifies principles but needs
direction to identify application
5. Not applicable: not observed/not applicable
*The goal of the Ball State Dietetic Internship is to have 80% or more of interns attain a level of
competent for each ACEND competency.
Directions: Using the ratings above, please evaluate the intern on the following competencies:
NOTE: The online forms cannot be saved or edited after submission. Please e-mail ljballenger@bsu.edu
if you would like a copy e-mailed to you.

Q2. Please fill out the following information:

Intern name (First and Last):

Rosemarie Biancardi

Facility:

Community Hospital Anderson

Preceptor Name (First and

Last):

Jenny Martin

Preceptor E-mail:

jmartin@ecommunity.com

Date:

8/8/16

Q3. Name of person completing the form (if different from the preceptor):

Q4. Based on the ratings on the first page, please evaluate the intern on the following competencies
related to Professional Attributes:
Novice Beginner Beginner
Proficient
_____ (6 ___ (7
___ (8 Competent Competent __ (10
Not
pts)
pts)
pts)
__ (9 pts) __ (10 pts)
pts)
applicable
Prepare appropriately
for rotation
Demonstrate
collaboration/teamwork
Demonstrate proactive
problem-solving skills
Demonstrate customer
focus
Demonstrate risk-taking
Demonstrate critical
thinking
Demonstrate flexibility
Demonstrate time
management
Demonstrate work
prioritization
Demonstrate advocacy
Demonstrate work ethic
Develop goals and
objectives
Respect life
experiences, culture
diversity, educational
background
Demonstrate negotiation
skills
Demonstrate
assertiveness
Develop effective oral
communication skills
Develop effective written
communication skills
Use informatics
technology
Dress is appropriate for
given work setting

Q5. Please list any additional comments about the intern's Professional Attributes:

Q12. Based on the ratings on the first page, please evaluate the intern on the following competencies
related to the Nutrition Care Process:
Novice Beginner Beginner
Proficient
_____ (6 ___ (7
___ (8 Competent Competent __ (10
Not
pts)
pts)
pts)
__ (9 pts) __ (10 pts)
pts)
applicable
Assess the nutritional
status of individuals or
groups
Diagnose nutrition
problems and create
problem, etiology,
signs and symptoms
(PES) statements
Plan and implement
nutrition interventions to
include prioritizing the
nutrition diagnosis,
formulating a nutrition
prescription,
establishing goals and
selecting and
managing intervention
Monitor and evaluate
problems, etiologies,
signs, symptoms and
the impact of
interventions on the
nutrition diagnosis

Q13. Please list any additional comments about the intern's performance using the Nutrition Care
Process:

Q15. Based on the ratings on the first page, please evaluate the intern on the following
competencies related to Enteral/Parenteral Calculations:
Novice Beginner Beginner
Proficient
_____ (6 ___ (7
___ (8 Competent Competent __ (10
Not
pts)
pts)
pts)
__ (9 pts) __ (10 pts)
pts)
applicable
Correctly calculates
patient energy and
nutrient needs
Selects, recommends,
and implements enteral
and/or parenteral
formulas appropriate to
the medical condition
and based on
acceptable dietetic
practice and scientific
literature
Correctly calculates
energy and nutrient
content of various
enteral and parenteral
formulas
Develops and
implements
appropriate transitional
feeding plans

Q14. Please list any additional comments about the interns enteral/parenteral calculations:

Q16. Based on the ratings on the first page, please evaluate the intern on the following
competencies related to
Medical Record Documentation:
Novice Beginner Beginner
Proficient
_____ (6 ___ (7
___ (8 Competent Competent __ (10
Not
pts)
pts)
pts)
__ (9 pts) __ (10 pts)
pts)
applicable
Complete
documentation that
follows professional
guidelines, guidelines
required by health care
systems and guidelines
required by the
practice setting
Writes organized,
clear, concise
statements
Uses correct spelling
and grammar

Q17. Please list any additional comments about the interns medical record documentation:

Q6.
Please comment on the interns areas of strength:
Flexible. Does not let stress affect her work. Able to pull out all important/pertinent details when looking at chart. Gets along well with
others. Able to correctly identify nutritional problems/diagnosis statements.

Q7. Please comment on the interns areas for improvement:

Work of correcting misspelled words before saving work into chart as well as using correct punctuation in documentation. Continue
to work on time-management and prioritizing consults/assessments (this will become easier with time/experience)

Q8. At this point, the intern can perform (check all that apply):
Staff assistance (ability to assume 50% of dietitians usual work)
Staff relief (ability to assume the majority of entry-level dietitians work)
Neither

Q9. Please answer the following questions about the intern's attendance:
Please specify the number of
days the intern was late during
the rotation:

Please specify the number of

days the intern was absent
during the rotation:

Did the intern make up all if

the days days/hours he/she
was absent? (yes/no)

N/A

If late or absent, the intern

contacted me ahead of time
to explain the situation?
(yes/no)

N/A

Q10. Final Comments:

Rose is able to thoroughly assess at least 8 patients daily.

Q11. Would you hire this intern for employment? (yes/no) Any comments?
Yes

Location Data

Location: (39.885406494141, -85.97380065918)

Source: GeoIP Estimation