a ate OAL] ‘assess andmark] NotYet | Borderline [ Competent | Professional | N/A 1@ following domains | Competent (1) (2) (3) (4) Pre-procedure a fo ‘and organtzatlon, Including patient comfort) jlonal / ing cxmmontaton / conment and / ‘consideration ‘towards the patient) ‘Knowledge (Of Indlations, anatomy, / quipment and technique) 7 ‘Technical aspects of (Would technical performance ‘yleld a useful return) AE Total Max (Max possible /36): I Comments: Abe i Thomas Hemmings bosizag Assessors signivuve : Ke Neck actyust ment - Dete’ 29/z2/ar‘Suggestions for development (assessor commonts): Cryliun oe Leplaum atch I Cansert cleey eA Aos (sped 7 from this experience, Selfrefiection (fo be completed by the Int went to ensure the next what would you do differently next time, What steps can you Im time you perform this procedure you will do It more professionally: Ensure expla talag Clearly Gbadl Whar Ina ting ‘Tgreed Action (Intern and Assessor initial): Page 2 of 2