Please assess end mark the following domaine Wot Yet Competent (a) Borderline (2) Competent Q) Professional ] NIA (4) ‘Pre-procedure (Room and equipment sat up ‘and organization, Including “including communication, consent and consideration ‘towards the patient) (Of ndlestions, anetomy, ‘equipment and technique) Gor ‘Technical aspects of (Would technical performance ‘veld a useful return) ‘Adapts procedure to accommodate patient and/or events: Post-procedure Beara ‘communication and the Total Max (Max possible /36): Sol3e Comments:‘Suggestions for development (assessor comments): ‘Self-refiection (fo be completed by the intern) — what did you learn from this experience, 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: Work on Speed ‘Agreed Action (intern and Assessor initial): Page 2 of 2