Please assess and mark | _NotVet | Borderline the following domains Competent (1) (2) ‘Competent 3) Professional @) NA Pre: (Room and {tnd organtation, Ink atlent comfor econ at ue os Pi jional ay h {including communteation, ‘consent and ‘towards the patient) ‘consideration (OF indications, anstomy, ‘equipment and technique) (Would ‘Technical aspects of sechnleal yields uaetl return) dure Total Max (Max possible /36): ‘Comments: Pritt Guth LK -a ‘Suggestions for development (assessor comments): Gok Combelrn compat — cord / Wovd (role pn HY Drow pr | comple integuetred Exo . Seifeflection (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: ~ Carat thot you, ant Lare %,. ok na 0 ae tote pracree 4 make sure Kann vury Smootete, ‘Agreed Action (Intern and Assessor initial): Page 2 of 2