Evaluation for Diet Interview
Evaluation for Diet Interview
Part I: Directions
A. Score each item by the number corresponding to the response most accurately describing the student’s performance.
2= student completed item as stated
0= student did not complete the item as stated
B. All 0’s must have documentation explaining and/or giving examples of how the student failed to meet the standard.
Part I: Standards
1. Student utilizes time appropriately by scheduling a time for the interview.
2= student completed the item as stated
0= student did not complete the item as stated
Comments:
2. Student addresses patient by name using appropriate title.
2= student completed the item as stated
0= student did not complete the item as stated
Comments:
3. Student introduces self appropriately by name and title.
2= student completed the item as stated
0= student did not complete the item as stated
Comments:
4. Student ensures the proper environment for the interview (i.e. appropriate setting, lighting, privacy)
2= student completed the item as stated
0= student did not complete the item as stated
Comments:
5. Student explains the purpose for the interview and for obtaining a diet history.
2= student completed the item as stated
0= student did not complete the item as stated
Comments:
6. Student demonstrates the ability to conduct interview without referring to the “form” or paper to cause distraction.
2= student completed the item as stated
0= student did not complete the item as stated
Comments:
7. Student uses time effectively, efficiently, and does not inappropriately rush or prolong the interview. (Suggested time for in-depth interview 30-45 minutes).
2= student completed the item as stated
0= student did not complete the item as stated
Comments:
8. Student closes the interview by preparing the patient for closure by making plans for the next contact for any additional arrangements for follow-up care.
2= student completed the item as stated
0= student did not complete the item as stated
Comments:
Part II: Directions
A. Score each item by the number corresponding to the response most accurately describing the student’s performance.
B. All 0’s must have documentation explaining and/or giving examples of how the student failed to meet the standard.
Part II: Standards
1. Student uses the appropriate non-verbal communication skills during the interview: facial expressions, voice (quality and loudness), maintaining eye contact, physical body position (faces patient at eye level if possible).
3- consistently utilizes appropriate skills throughout the interview
2- utilizes the appropriate skills with 1-2 errors
1- makes 3 errors in non-verbal communication skills
0- makes more than 3 errors in non-verbal communication skills
Comments:
2. Student appropriately investigates vitamin, mineral, food supplement or herbal usage/composition, length of use and dose.
3- thoroughly investigates vitamin, mineral, food supplement and herbal use
2- investigates vitamin, mineral, food supplement and herbal use with one omission
1- investigates vitamin, mineral, food supplement and herbal use with two omissions
0- investigates vitamin, mineral, food supplement and herbal use with more than two omissions
Comments:
3. Student uses effective questioning skills such as open-ended questions and closed questions where appropriate.
3- consistently uses effective questioning skills throughout the interview
2- uses effective questioning skills with 1-2 errors
1- makes 3 errors in using effective questioning skills
0- makes more 3 errors in using effective questioning skills
Comments:
4. Student uses language appropriate to patient’s ability to understand
3- consistently uses appropriate language throughout the interview
2- uses appropriate language with 1-2 errors
1- makes 3 errors in using appropriate language
0- makes more than 3 errors in using appropriate language
Comments:
5. Student avoids using ineffective communication skills such as: wording question with an implied answer, combining two questions into one, monopolizing discussion, expressing own values/bias/attitudes.
3- avoids using ineffective communication skills throughout the interview
2- uses ineffective communication skills 1-2 times during the interview
1- uses ineffective communication skills 3 times during the interview
0- uses ineffective communication skills more than 3 times during the
interview
Comments:
6. Student can maintain control of the interview by redirecting patient’s inappropriate discussions, directing questions smoothly to reach closure, and probing into patient’s response incongruencies.
3- maintains control throughout the interview
2- maintains control with 1-2 errors during the interview
1- makes 3 errors in maintaining control of the interview
0- loses total control (more than 3 errors) of the interview
Comments:
7. Student demonstrates active listening skills by including the following as appropriate: restatement of patient’s words, appropriate silences and pauses to demonstrate interest and concern, and interpretation of patient’s “story” to better determine patient’s needs/concerns.
3- demonstrates skills consistently throughout the interview
2- demonstrates skills with 1-2 errors
1- demonstrates skills with 3 errors
0- has difficulty with listening skills and makes more than 3 errors
Comments:
8. Student demonstrates ability to enhance communication process by the following: encouraging patient to continue, exploratory questioning to gain more detailed insight, empathy to patient’s problems, and self-disclosure (as appropriate).
3- demonstrates ability to enhance communication process consistently throughout the interview
2- demonstrates ability to enhance communication process with 1-2 errors
1- demonstrates ability to enhance communication process with 3 errors
0- has difficulty with the communication process and makes more than 3 errors
Comments:
9. Student provides the patient the opportunity to verbalize concerns and describe problems in appropriate detail.
3- consistently allows patient to discuss concerns and problems as appropriate
2- allows patient to discuss concerns and problems with 1-2 errors
1- allows patient to discuss concerns and problems but not in sufficient detail or in excess of what is needed to complete the interview, making 3 errors
0- does not allow patient to express concern or problems (more than 3 errors)
Comments:
__/43=__ % Total score for all pages
General Comments:
__________________ _____ _________________ _____
Student Signature Date Evaluator Signature Date