itor ne & het Wimber, 1 Lives. He _mecipan hilates loll menos nbn (sue Sota Oldies ball we Spats 2/4 [Od eas ir [Not Yet — ‘Competent Professional | NA | the following domair Competent common cope | | my | | Pre-procedure | ono land organtz A | [Professional approach including communieation, Consent and consideration "wards the patient) howled (ot indications, anatomy, equipment and technique) -[] | Technical aspects of rocedure (Would technica performance L | "led a useful return) apts procedure fo secommodate pati ‘andjor events Post: re ‘management {including hyotene, ommunteation and consideration towards the oH Completes required ‘documentation Self-analyses and is re ‘own ‘aware of own limitations, seeks help ‘when appropriate \|S ‘Overall ability to form procedure probability of success Total Max (Max possible _/36): 146 ‘Comments: Zejor comments): “Suggestions for development (asse God Breohe oF mo hehari Gor ak, Mist Xo like & vttrche-y V7. | Self-reflection (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 }