Please assess and mark] Not Yet | Borderline Competent | Professional | NIA the following domains | Competent () (2) ey “ a Treuding communication, Consent and consideration Towards the patient) Kens (ot Soe equipment and technique) Tochnicalaspests of (ould tachnieal performance yield w useful reture) SIAL NIA Total ‘Comments: Max (Max possible /36): I iar fk‘Suggestions for development (assessor comments): ‘Selfveflection (fo be completed by the intern) — what did you lear 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