TRAINEE DETAILS Trainee Name: Hospital: ……………………………………………………………………….. Date of Examination: …………………………………………………….. Introduces self to patient 1 2 3 4 5 and obtains relevant No introduction or Minimal Complete clinical details history introduction and introduction and incomplete history history Explain examination 1 2 3 4 5 Incomplete or Explanation Full, succinct misinformation complete but explanation with indication and limitations Consent for aneuploidy 1 2 3 4 5 screening and pre and Incomplete or Explanation Full, succinct post-test counselling misinformation complete but explanation brief including limitations Selection of probe and 1 2 3 4 5 examination presets Inappropriate Correct but some Correct and probe or inability hesitancy in use of confident use of to select settings equipment equipment Demonstration of applied 1 2 3 4 5 physics Inability to Some Detailed demonstrate understanding of understanding of application of use of frame rate use of frame rate physics to setting and persistence to and persistence optimise image Applied understanding of 1 2 3 4 5 ALARA power / Understands Always Doppler on principles of demonstrates inappropriately, ALARA but not ALARA little or no always principles, full demonstration of demonstrated understanding ALARA Use of depth, focus and 1 2 3 4 5 zoom functions Suboptimal image Optimises image Optimises image quality but uncertainty in appropriately with use of machine familiarity functions Assess cervix and uterine 1 2 3 4 5 contents including fetal Incomplete Structures Systematic number and amniotic fluid demonstration demonstrated by approach in both volume unsystematic transverse and approach longitudinal planes Assess placenta: 1 2 3 4 5 Incorrect Structures Systematic Location demonstration demonstrated but approach in both Anatomy unsystematic transverse and Appearance approach longitudinal planes
TRAINEE DETAILS Trainee Name: ……………………………………………………………………….. Hospital: Date of Examination: …………………………………………………….. Introduces self to patient and obtains relevant clinical details 1 No introduction or history 2 3 Minimal introduction and incomplete history 4 5 Complete introduction and history Explain examination 1 Incomplete or misinformation 2 3 Explanation complete but 4 5 Full, succinct explanation with indication and limitations Consent for aneuploidy screening and pre and post-test counselling 1 Incomplete or misinformation 2 3 Explanation complete but brief 4 5 Full, succinct explanation including limitations Selection of probe and examination presets 1 Inappropriate probe or inability to select settings 2 3 Correct but some hesitancy in use of equipment 4 5 Correct and confident use of equipment Demonstration of applied physics 1 Inability to demonstrate application of physics to setting 2 3 Some understanding of use of frame rate and persistence to optimise image 4 5 Detailed understanding of use of frame rate and persistence Applied understanding of ALARA 1 power / Doppler on inappropriately, little or no demonstration of ALARA 2 3 Understands principles of ALARA but not always demonstrated 4 5 Always demonstrates ALARA principles, full understanding Use of depth, focus and zoom functions 1 Suboptimal image quality 2 3 Optimises image but uncertainty in use of machine functions 4 5 Optimises image appropriately with familiarity Assess cervix and uterine contents including fetal number and amniotic fluid volume 1 Incomplete demonstration 2 3 Structures demonstrated by unsystematic approach 4 5 Systematic approach in both transverse and longitudinal planes Assess placenta: Location Anatomy Appearance 1 Incorrect demonstration 2 3 Structures demonstrated but unsystematic approach 4 5 Systematic approach in both transverse and longitudinal planes
17-CMFM-IHCE-12-Week-Assessment.docx