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DOPS template 2

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11 views

DOPS template 2

m

Uploaded by

mohamedalaswad12
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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DOPS Assessment Form:

Name: Rotation:
Date of Assessment:
Name and Position of Assessor:
Procedure/Skill : Low (one problem) Medium (2) High (more than 2)
Patient name: Age: Gender:
Procedure: Setting:
EPA tested (1-20):
Competency Rubric * Remarks
1 2 3 4
Describes indications
for, relevant anatomy
and technique of
procedure
Obtains informed
consent
Demonstrates
appropriate
preparation
preprocedure
Provides appropriate
analgesia, an aesthesia
or sedation
Monitors and
communicates with
patient throughout the
procedure
Perform technical
aspects of tasks
appropriately
Observes universal
precautions and
occupational health and
safety
Recognizes and
manages complications
Describes post
procedure management
plan to patient and
colleagues
Overall Clinical
Competence for DOP

DOPS duration: Observing________minutes


Feedback to intern:_______minutes
Please comment on the intern’s performance. (Describe what was effective,
what could be improved and your overall impression.
Please specify suggested actions for improvement and provide a timeline:
Signature of Assessor: Date:
Signature of Intern: Date:
Signature of Clinical supervisor:

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