Intern Name & Student Number: oe Ue _— G Assessor name and state: DW Soe = vw ANSE / AUSTRALIA Procedure to be assessed: Date: 23/1 [22 Please assess and mark | Not Yet Borderline | Competent | Professional | N/A the following domains | Competent a @) (3) @ Pre-procedure preparation (Room and equipment set up ‘nd organization, including a“ ationt comfort) Professional approach (including communication, consent and consideratlon towards the patient) Knowledge | J. (Of dications, anatomy, | Ses, —~—| ed Technicalaspects of oe dure (Would technieal performance lel @ useful return) to Adapts procedure to accommodiate patient and/or events vA a Post-procedure ee — = _— ea (studing hygiene, consideration towards the patlont. Completes required documentation Si and i awal m limitations, seeks hi when appropriate ‘Overail ability to zi perform procedure | probability of success Total ‘Max (Max possible /36): Comments: 2.2 4 Yong as[ ae bn « ore um fine‘Suggestions for development (assessor comments): wate sega wlke-une ma, 500 dl! Self-refiection (to be completed by the intern) — what did you learn from this experlence, what would you do differently next time. What steps can you implement to ensure the next time you perform this procedure you will do It more professionally: Remember to ves terms the Patient will understand . | Agreed Action (Intern and Assessor initial): Page 2 0f2