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CraVnacua eMart edu.au Piease assess and mark | _NotYet | Borderline | Competent | Professional | NIA the following domains | Competent (1) (2) 3) (4) Pre-procedure ‘preparation (Room and equipment setup ‘and ergantzaton, including atlent comfort). ‘Technical ‘procedure (Would technical performance ‘veld a useful return) Adapts procedure to accommodate patient aware of own limitations, seeks help le when appropriate ‘Overall ability to perform procedure / probability of success aa Total Max (Max possible /36): / Comments: Prty geek Ur ‘Suggestions for development (assessor comments): Free UF wm Lie one sroveel, Carel fh omgego with Kee prtrovt o Lite Mme mitted ttalkny ot thom fr te wrote interetun, Ae wy fo by thi might he talking fe trom fitter ab rear guals a ha Hur asking qoerh us. Syme Sam diec_ a litte surnplect Aralanatvy [Anguraw was a little conpicatedt. Self-refiection (to 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: | ‘Agreed Action (Intern and Assessor initial): Page 2 of 2 Piease assess and mark the following domains Pre: jure Wot Yet | Borderline Competent (1) (2) ‘Competent (3) Professional | N/A preparation {Room and equipment set up ‘and organization, Including Patient comfort) nal approach (4) “Ineluding communication, ‘consent and consi ‘towards the patient) ‘Knowl (0f indications, an Suipment end fechas) ‘Technical aspects of (Would technical performance ida usetul ALTA cS Max (Max possible /36): / qed. ixan apa potints over lec. [ Suggestions for development (assessor comments): in HUM Crt wasnt cnplorey clea) fare make Sue teeg get to orl Wouga esp. knee Heim Check po parte). Noterhiaa lhas fe he clove Witte Go? keruc Loci fo clot rene hop tata qe aA\W AATACLIA SCCens You CH Uc A cover . 1S 4 Grek LU screen - Quek oxom othvil- - ‘Self-reflection (to be compieted 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: ‘Agreed Action (Intern and Assessor initial): Page 2 of 2 and mark the following domains Not Yet | Borderline ‘Competent a) 2) ‘Competent (3) (4) Professional NIA ‘Knowledge (of indications, anatomy, equipment and technique) ‘Technical aspects of procedure (Would technical performance Yylold @ useful return) ‘Adapts procedure to accommodate patient ‘andlor events Post-procedure management {including hygiene, communication and ‘consideration towards the patient) ARIA Overall ability to perform procedure / lity of st Total Max (Max possible /36): ! ‘Comments: Goer tem — wy corpuce OH he pshm yakalvas o pi.cin put Heir om hand trdir dhe - Guek We A-NTTS ~ rere oem i ‘Suggestions for development (assessor comments): Cam ui KPLLYE as aneurcen Pry He. shade wer ie 6 WR fee |? gin f Bom meta | m te

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