DAILY 2-WAY COMPETENCY EVALUATION

Trainee Name: Trainer Name: Date:

TRAINER

Skill Assessed

Beginner

Developing Competence

Competent

1. Trainee’s ability to make the procedure comfortable for the patient

2. Trainee’s ability to dilate the cervix safely

3. Completeness of procedures trainee performs (upon 1st evaluation of POC)

4. Trainee’s ability to identify potential problems

5. Current level of confidence in the trainee’s ability to perform this procedure safely without supervision	Low						High
	1	2	3	4	5	6	7	8	9

Comments/Examples:

^{– – – – -Trainer complete, fold here, give to Trainee to complete, then open & discuss – – – – –}

TRAINEE

Skill Assessed

Beginner

Developing Competence

Competent

1. My ability to make the procedure comfortable for the patient

2. My ability to dilate the cervix safely

3. Completeness of procedures (upon 1st evaluation of POC)

4. My ability to identify potential problems

5. Current level of confidence in my ability to perform this procedure safely without supervision	Low						High
	1	2	3	4	5	6	7	8	9

License