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Clinical Observation Form

for Tenure Track Faculty
This form is to be completed by administrators, department chairs, or tenured faculty members
performing formal observations for inclusion in a tenure track faculty member’s portfolio. When possible,
observers are encouraged to meet with the tenure track faculty member prior to the observation to gain
context for the class session that will be observed and to identify any areas where the faculty member
would like specific focused feedback.

This form must be completed and returned to the faculty member within one week of the formal
observation. It is suggested but not required that the observer meet with the faculty member to review
feedback in person.

Class and Section

Instructor’s Name            
Observed

Observer’s Name       Date of Observation Click here to enter a date.

Relation of Observer to Number of Students

           
Instructor Enrolled

Facility Where
Observation Occurred

Number of Students
College Choose an item. On time:       Tardy:      
Attending

DIRECTIONS FOR ASSIGNING RATINGS

For each category below, a description is included to guide the observation. It is not necessary for all bullets to
be addressed or observed; rather, the bulleted list offers direction and suggestions to guide ratings and
comments. In commentary, describe observed strengths as well as areas for growth. Commentary is required for
each section.

After offering commentary, select the appropriate descriptive rating based on the following definitions:
 Strong—evidence indicates that the instructor exceeds expectations. Specific examples illustrating
strength should be included in commentary to justify the rating.
 Satisfactory—evidence indicates that the instructor meets expectations and the observer does not
identify any specific concerns in a given area.
 Needs Improvement—evidence indicates minor to moderate concerns in the given area and focused
support is needed. A detailed explanation of concerns and the type of support needed should be outlined
in commentary.
 Significant Concern—evidence indicates significant concerns in the given area, suggesting that a
formal action plan may be needed. A detailed explanation of concerns and necessary improvements

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should be outlined in commentary.

RESPONSIBILITIES OF OBSERVER

I have carefully read the directions AND watched the short training video Initial Here:
available on the Tenure Website (ccc.edu/tenure).      

I understand that I am responsible for writing comments for each section below. Initial Here:
     

I understand that the tenure-track faculty member must write a response to this Initial Here:
observation. In order to facilitate that process, I will return this completed form to the      
faculty member within one calendar week of the observation.

I understand that in order to provide appropriate feedback to the tenure-track Initial Here:
faculty member I must observe the clinical for a minimum of three (3) hours      
either at the start of the clinical day or the end of the clinical day.

SYLLABUS

The following list of elements is offered to guide your comments and rating:

 Official clinical description and clinical prerequisites are stated

 Clinical objectives and Student Learning Outcomes are stated, are appropriate for the clinical, and match departmental
master syllabus if existent
 Student Learning Outcomes are measureable
 Grading system is stated clearly and standards used to assess students’ work are adequately explained
 Variety of assignments listed (e.g., in-class tests, lab reports, essays, etc.) indicate that Student Learning Outcomes will
be assessed using multiple methods
 Clinical policies (e.g., ADW, late work, participation) are stated clearly, and all policies are consistent with
college/facility policies
 Adequate information regarding clinical content (e.g., required texts and materials, clinical outline, etc.) is included
 Adequate information regarding student support (e.g., time to assist student/provide directions as indicated, and
appropriate academic support services) is included
 Syllabus is easy to navigate, well written, and professional

Comments (observations, feedback, and questions for faculty member):

     

☐ Strong: ☐ Satisfactory: ☐ Needs Improvement: ☐ Significant Concern:

exceeds expectations meets expectations minor to moderate action plan may be needed
concerns

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CLINICAL REQUIREMENTS TO BE OBSERVED

During the clinical session observed the following items must be present. Check all boxes that apply.

 Appropriate selection of patients for student assignments

 Formalized mechanism for students to contact the faculty throughout the day
 Professional appearance for the clinical setting
 Identified nursing unit contact name and means for faculty to make contact
 Plan for post conference activities
 Formalized mechanism to determine students are prepared for patient assignments
 Formalized mechanism to ensure client and student safety
 Knowledge of how to access policies and procedures
 Knowledge of how to access the electronic health record
 Knowledge of how to initiate emergency management
 Adherence to HIPPA

DESCRIPTION OF CLINICAL SESSION OBSERVED

Describe the clinical session observed including the session’s intended purpose, the types of instructional
techniques used (e.g., discussion, small group activities, pre-conference/post-conference, medication
administration, shift report, patient assessment, patient care, prioritization of assignments for students, interaction
with students and clinical site staff, etc.), and the sequence of activities, including the approximate amount of
time spent on each activity.

     

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LEARNING ENVIRONMENT

The following list of elements is offered to guide your comments and rating:

 Clinical is managed in a way that is conducive to learning and demonstrates respect for students
 Distractions (cell phones, side talking, etc.) are minimized and do not interfere with learning
 Policies stated in the syllabus are appropriately and consistently enforced
 Instructor’s expectations of students are clear and consistent throughout the clinical session
 Instructor works to ensure that students are on task (e.g., by circulating during clinical hours, by acknowledging off-task
behavior and redirecting students, adherence to HIPAA guidelines, demonstrates safety precautions for self, students, and
the client, etc.)

Comments (observations, feedback, and questions for faculty member):

     

☐ Strong: ☐ Satisfactory: ☐ Needs Improvement: ☐ Significant Concern:

exceeds expectations meets expectations minor to moderate action plan may be needed
concerns

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CONTENT AND LESSON ORGANIZATION

The following list of elements is offered to guide your comments and rating:

 Clinical session’s purpose is clear and time is organized effectively to meet the session’s purpose
 Clinical session’s purpose is aligned with one or more of the stated Student Learning Outcomes
 Lesson is organized logically and content is sequenced appropriately
 Content covered was appropriate to the clinical session needs
 Pacing and difficulty of material are appropriate for the level of the class
 Instructor’s command of subject matter is evident (TO BE COMPLETED BY OBSERVERS WITH DISCIPLINE
TRAINING ONLY)
 Interactions with hospital personnel guide appropriate student assignments
 Feedback is gathered from hospital personnel on student performance

Comments (observations, feedback, and questions for faculty member):

     

☐ Strong: ☐ Satisfactory: ☐ Needs Improvement: ☐ Significant Concern:

exceeds expectations meets expectations minor to moderate action plan may be needed
concerns

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PRESENTATION AND DELIVERY

The following list of elements is offered to guide your comments and rating:

 Instructor conducts him/herself in a professional manner

 Instructor begins and ends clinical on time
 Instructor manages time effectively to maximize students’ time engaged in learning activities
 Instructor opens and/or closes lesson effectively, situating learning within the broader context of the course
 Instructor’s verbal communication is effective (e.g., instructor enunciates clearly and can be heard and understood
throughout the room, etc.)
 Instructor’s written communication is effective (e.g., use of board, handouts, PowerPoint, visual aids, etc.)
 Instructor is clear when delivering content, giving directions, and answering questions
 Instructor helped students to grasp challenging material by presenting examples to clarify points, relating new ideas to
familiar concepts and students’ prior knowledge, restating important ideas at appropriate times, and/or varying
explanations of complex material
 Students are actively engaged (e.g., taking notes when appropriate, participating in activities and discussions;
demonstrating body language that suggests engagement)
 Communicates effectively with hospital personnel in regard to patient care
 Provides safe and effective patient care
 Delivery of patient care as indicated follows hospital policy and procedure

Comments (observations, feedback, and questions for faculty member):

     

☐ Strong: ☐ Satisfactory: ☐ Needs Improvement: ☐ Significant Concern:

exceeds expectations meets expectations minor to moderate action plan may be needed
concerns

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CRITICAL THINKING

The following list of elements is offered to guide your comments and rating:

 Instructor employs methods that develop students’ ability to communicate and problem solve using the discipline’s
thinking, practice, and procedures
 Clinical session provides the appropriate level of challenge and is designed to help students grow intellectually and think
in new ways
 Method of instruction helps to build critical thinking
 Instructor creates an environment that fosters students’ intellectual curiosity

Comments (observations, feedback, and questions for faculty member):

     

☐ Strong: ☐ Satisfactory: ☐ Needs Improvement: ☐ Significant Concern:

exceeds expectations meets expectations minor to moderate concerns action plan may be needed

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STUDENT ASSESSMENT AND SUPPORT

The following list of elements is offered to guide your comments and rating:

 Instructor exhibits ability to determine whether or not students understand material and uses formative assessment to
determine appropriate pacing of instruction and next steps (e.g., post-procedure, etc.)
 Instructor promotes students’ reflection on, and ownership of, their own learning progress by helping them self-assess
and determine appropriate next steps
 Instructor displays respect for and interest in students (e.g., uses of students’ names, maintains eye contact with students
and clients, greeting students as they enter pre-conference, etc.)
 Instructor identifies and assists students who are struggling
 Instructor conveys confidence in each students’ ability to learn
 Instructor engages all students, including both quiet or low-achieving students and those who are vocal or successful
 Instructor fosters student peer interaction that supports learning and promotes cooperation, collaboration and teamwork
 Instructor fosters student interaction with hospital personnel

Comments (observations, feedback, and questions for faculty member):

     

☐ Strong: ☐ Satisfactory: ☐ Needs Improvement: ☐ Significant Concern:

exceeds expectations meets expectations minor to moderate action plan may be
concerns needed

ADDITIONAL COMMENTS AND QUESTIONS

Use this space for any of the following purposes:

1. to comment specifically on any focus area the instructor has identified for the observation;
2. to report on progress since the last observation (when applicable);
3. to provide any questions you had during the observation regarding instructional or classroom
management choices;
4. to offer any additional commentary not covered above;
5. to offer summative commentary to highlight notable strengths or areas for growth and/or to offer focus
for the faculty member’s future professional development;
6. to include any needed action plans. (An action plan must be developed in coordination with the
candidate and must include an agreed upon list of measurable next steps with dates for completion and
follow up.)

Comments (observations, feedback, and questions for faculty member):

     

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Signature: _________________ Date: Click here to enter a date.

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