Post-Learning Clinical Confidence Assessment[edit | edit source]
| Learner Identification | |
|---|---|
| Date of Assessment (Year-Month-Day): | |
| Name (First Name, Last Name): | |
| Age (years): | |
| Gender: | 🔲 Male 🔲 Female 🔲 Non-Binary |
| Country of Practice: | |
| Contact Information (email): | |
| Country Code + Phone Number: | |
| Clinician Status: | 🔲 Resident 🔲 Attending Physician 🔲 Attending Surgeon 🔲 Other:________________________ |
| Discipline/Specialty: | 🔲 Medical Officer (Non-Specialist Physician) 🔲 General Surgery 🔲 Neurological Surgery 🔲 Obstetrics and Gynecology 🔲 Ophthalmic Surgery 🔲 Oral and Maxillofacial Surgery 🔲 Otolaryngology 🔲 Pediatric Surgery 🔲 Plastic and Reconstructive Surgery 🔲 Thoracic Surgery 🔲 Urology 🔲 Vascular Surgery 🔲 Other:________________________ |
| Total Years of Post-Fellowship Clinical Practice Experience: | |
| Work Environment: | 🔲 Community facility 🔲 Primary health center 🔲 First-level hospital 🔲 Second-level hospital 🔲 Third-level hospital 🔲 Other:________________________ |
| Total Years of Residency and Fellowship Training Completed: | |
| Clinical Skill To Be Tested: | Ultrasonographic Diagnosis of Pediatric Distal Forearm Fractures |
| Amount of Experience or Training With Ultrasonographic Diagnosis of Pediatric Distal Forearm Fractures To Date: | |
| Amount of Experience or Training With Ultrasonographic Diagnosis of Pediatric Distal Forearm Fractures To Date: | |
| Date Range Over Which the Training Materials Were Accessed (Year-Month-Day to Year-Month-Day): | |
| Hours of Study of Online Materials: | |
| Number of Times Procedure Was Practiced With the Simulator: | |
| Duration of Simulator Practice Time: | |
| Site of Clinical Evaluation (Facility Name, City, Country): | |
| Clinical Evaluator(s): | |
| Number of Procedures in Patients: | |
For this post-learning clinical confidence assessment, please rate your responses from 1-5, with 1 being “Disagree” to 5 being “Agree.”
| Cognitive | |||||||
| I know how to perform ultrasonographic diagnosis of a pediatric distal forearm fracture. | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
| I understand the content of ultrasonographic diagnosis of a pediatric distal forearm fracture and can demonstrate it to others. | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
| I can verbally explain the purpose and principle of performing ultrasonographic diagnosis of a pediatric distal forearm fracture. | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
| I can verbally explain the sequence and interrelationship between each step. | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
| Psychomotor | |||||||
| I can precisely imitate the instructed steps and actions of ultrasonographic diagnosis of a pediatric distal forearm fracture. | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
| I can smoothly complete the procedure steps of ultrasonographic diagnosis of a pediatric distal forearm fracture. | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
| I can monitor my ultrasonographic diagnosis of a pediatric distal forearm fracture for improvements | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
| I can monitor my ultrasonographic diagnosis of a pediatric distal forearm fracture procedures and make proper adjustments as needed | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
Adapted from the L-SES (Learning Self-Efficacy Scale) for Clinical skill assessment described in Kang Y-N, Chang C-H, Kao C-C, Chen C-Y, Wu C-C (2019) Development of a short and universal learning self-efficacy scale for clinical skills. PLoS ONE 14(1): e0209155. https://doi.org/10.1371/journal.pone.020915
Acknowledgements[edit | edit source]
This work is funded by a grant from the Intuitive Foundation. Any research, findings, conclusions, or recommendations expressed in this work are those of the author(s), and not of the Intuitive Foundation.
