☐ Aseptic Technique Application of universal standards for infection prevention. INTERVENTION DIRECTION GUIDANCE AUTONOMOUS EXPERT ☐ ☐ ☐ ☐ ☐ Narrative Comments ☐ Post-Procedure Management/Documentation Ability to arrange for care and to document properly the INTERVENTION DIRECTION GUIDANCE AUTONOMOUS EXPERT procedure, including the ☐ ☐ ☐ ☐ ☐ complications. Narrative Comments ☐ Organization/Efficiency Delivering care with optimal use of time and resources. INTERVENTION DIRECTION GUIDANCE AUTONOMOUS EXPERT ☐ ☐ ☐ ☐ ☐ Narrative Comments ☐ Professionalism Commitment to high standards of behavior and ethics. INTERVENTION DIRECTION GUIDANCE AUTONOMOUS EXPERT ☐ ☐ ☐ ☐ ☐ Narrative Comments ☐ Insight Recognition of the limits of one's experience and expertise. INTERVENTION DIRECTION GUIDANCE AUTONOMOUS EXPERT ☐ ☐ ☐ ☐ ☐ OVERALL PERFORMANCE Choose a of autonomy on the entrustment scale for the overall clinical activity being assessed. NEEDS NEEDS NEEDS MINIMAL AUTONOMOUS EXPERT INTERVENTIONS DIRECTIONS GUIDANCE Able to do without Able to do in complex Unable to do without Partially able to do with Mostly able to do with guidance; refinement situations; personal others’ actions. others’ directions. minimal guidance. possible with feedback. insight on performance. ☐ ☐ ☐ ☐ ☐ CanMEDS Roles Choose the role(s) addressed during the feedback. Medical Expert Communicator Collaborator Leader Health Advocate Scholar Professional ☐ ☐ ☐ ☐ ☐ ☐ ☐ Trainees' Comments/Reflections: Signatures: Trainee Faculty
☐ Aseptic Technique Application of universal standards for infection prevention. INTERVENTION ☐ DIRECTION ☐ GUIDANCE ☐ AUTONOMOUS ☐ EXPERT ☐ ☐ Post-Procedure Management/Documentation Ability to arrange for care and to document properly the procedure, including the complications. Narrative Comments INTERVENTION ☐ DIRECTION ☐ GUIDANCE ☐ AUTONOMOUS ☐ EXPERT ☐ ☐ Organization/Efficiency Delivering care with optimal use of time and resources. Narrative Comments INTERVENTION ☐ DIRECTION ☐ GUIDANCE ☐ AUTONOMOUS ☐ EXPERT ☐ ☐ Professionalism Commitment to high standards of behavior and ethics. Narrative Comments INTERVENTION ☐ DIRECTION ☐ GUIDANCE ☐ AUTONOMOUS ☐ EXPERT ☐ ☐ Insight Recognition of the limits of one's experience and expertise. Narrative Comments INTERVENTION ☐ DIRECTION ☐ GUIDANCE ☐ AUTONOMOUS ☐ EXPERT ☐ OVERALL PERFORMANCE Choose a of autonomy on the entrustment scale for the overall clinical activity being assessed. NEEDS INTERVENTIONS Unable to do without others’ actions. ☐ NEEDS DIRECTIONS Partially able to do with others’ directions. ☐ NEEDS MINIMAL GUIDANCE Mostly able to do with minimal guidance. ☐ AUTONOMOUS Able to do without guidance; refinement possible with feedback. ☐ EXPERT Able to do in complex situations; personal insight on performance. ☐ CanMEDS Roles Choose the role(s) addressed during the feedback. Medical Expert ☐ Communicator ☐ Collaborator ☐ Leader ☐ Health Advocate ☐ Scholar ☐ Professional ☐ Trainees' Comments/Reflections: Signatures: Trainee Faculty