can
i
Please assess and mark
the following domains
Borderline | Competent | Professional | N/A
@)
Q) (4)
Pre-procedure
preparation
(Room and equipment set up
‘ond organization, nluding
‘patient comfort)
a
Professional approach
Tineluding communication,
consent and consideration
towards the patient)
“
Kn
{0F indications, anatomy,
‘equipment and technique)
‘Technical aspects of
‘procedure
(Would technical performance
‘yield a useful return)
‘Adapts procedure to
agcommodate patient
and/or events:
‘Post-procedure
tourer,
communleaton
‘conideration towards the
‘Comments:
Total Max (Max possible (36): ($ /(G bs
Scanned with CamScanner
MildSuggestions for development (assessor comments):
jarn from this experience,
Seif-refiection (fo be completed by the intern) — what did you le
lement to ensure the next
what would you do differently next time. What steps can you it
time you perform this procedure you will do it more professior
mh ly alky my bre dive,
to" align wy BY leytr ss Cure Salt.
‘Tgreed Action (Intern and Assessor initial): :
Page 2 of 2
Scanned with CamScanner