INSTRUMENTATION PROFICIENCY cin vv PROCESS EVALUATION (cirets’one) Competency : perform scaling and root Competency: access own performance for planning ca quality and improvement Name Stetae Heche —tnetructor, Speugit Patient pate__@/3 iy A VI2AT li Cligte | 85% neede % A= Acceptable eeded 1 Needs Improvement v 95% needed Ue Unacceptable **Failure of starred items results in failure of proficiency** 1. Professionalism Criteria’ PASS. FAIL ‘Time Management/ Professional Behavior * ‘Asepsis/Infection Control * PASS FAIL I. Patient Education Criteria: In presence of Instructor. Informed pt. of procedure to be performed PASS FAIL, Explained the reasons for calculus removal PASS FAIL IL Instrumentation Instruments will be evaluated in Criteria all sextants deemed appropriate ‘A. Gracey 172 Grasp aK B 7 0 fulcrum A i 0 insertion AT 7 0 ‘Angulation/adaptation Ny nN 2 a 0 Wrist motion/activationiwalking stroke 2. Te 0 B. Gracey 11/12 Grasp BQ 1 0 Fulorum 1 0 Insertion 4 0 ‘Angulation/adaptation Qs i 0 Wrist motion/activation/walking stroke 2 CG) oO C. Gracey 13/14 Grasp a 7 o Fulcrum 4 0 Insertion 5 4 0 [Angulation/adaptation Fa ae 0 ‘Wrist motion/activationiwalking stroke OLUINID [VIS 2 Ww 0 IV. Explorers ‘A. Shepherd hook explorer Grasp/fulcrum PLLA (25 7 0 inser WO? @ 4 0 bar tin? explorer is Grasp/fulcrum y ry qe 7 T Insertion/activation ALON IN @""* 1 0 yeV. Sickle/Universal A HSS3 Grasp/fulerum pee IZ i 0 Insertion we 7 D 1 o ‘Activation/walking stroke pa e¥ DP af 0 ‘Angulation/ Adaptation pe 2 (GPA 0 B. Columbia 13/14 (Use on anterior and posterior teeth) Grasp/fulcrum 1 0 Insertion. a 1 0 Activation/walking stroke 1 oO Angulation/adaptation 2 ¢ TS oO C. 2045 (Use on anterior and posterior teeth) Grasp/fulorum @ i 0 Insertion 5 1 0 ‘Activation/waiking stroke 1 0 ‘Angulation/adaptation a 1 0 Vi. Self Assessment ‘Student completes self assessment* PASS: FAIL Discusses with instructor™ PASS: FAIL 2 / = % Give to grading instructor immediately following patient treatment; ee if not completed, an automatic failure of proficiency will result Mipcom TETNIQUE 1S CODD, Pospuee NED S Bl \NEROEMENT STUDENT EVALUATION/SELF ASSESSMENT Strengths: (Briefly state what you did well and why) Gnd achvaten Wl atl Cracoyo Areas to Improve: (Briefly state what you need to improve and how you will accomplish it) zi Werk or weet aebyaton (net faces ot fot Mmpe main, binges ae hie A been we Concho rtuole Insight: (What did you learn that was significant?) wl eee hem Kae secble dpwtler inlecporimal, phaiey threkee wll help not 4 it Suck dy Conceal.