Intern Name & Student Number: Procedure tobe sevesea: | WA ze, BABA Wie pres 0] tt al ears pele: See aes Dn AQ ee niversity AUSTRALIA Eanes Please assess and mark the following domaine 2) ‘Competent @ Pre-procedure ‘preparation (Gepm andeqment setup ant confor) sional approach Tineluging communication, Consent and consoerauon Towards the patent) procedure (oui echnical eftormance ‘falda wee reuse), ‘andlor events Post-procedure ‘management (ieluang Pyaiene, CStemanteaton and ‘documentation alyses andl of limitation helt when appropriate Overall ability to perform procedure / robabilly of success Total Max (Max possible (36): Vv ed aa jyAment :Suggestions Tor daveopinent assessor Comment - Vy aes acl bw err Aone ~ Keep vagy deep ware oA pre ® femsrm™m | Seif-refiection (lo 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: wa Neco woe porte on fue appltebun ia vegas to poder ls Sige. Gerda Hak pont op tersion) / Frgreed Ketion (intern and Assessor inital) pee imate tT Page 2012