Attachment B - Pre-Learning Clinical Confidence Assessment[edit | edit source]
Learner Identification | |
---|---|
Date of Assessment (Year-Month-Day): | |
Name (First Name, Last Name): | |
De-Identified Unique Study Code for Learner: | |
Age (years): | |
Gender: | π² Male
π² Female π² Non-Binary |
Country of Practice: | |
Contact Information (email): | |
Country Code + Phone Number: |
|
π² Clinician Status: | π² Resident
π² Attending Physician π² Attending Surgeon |
Discipline/Specialty: | π² Medical Officer (Non-Specialist Physician)
π² General Surgery π² Neurological Surgery π² Obstetrics and Gynecology π² Ophthalmic Surgery π² Oral and Maxillofacial Surgery π² Otolaryngology π² Pediatric Surgery π² Plastic and Reconstructive Surgery π² Thoracic Surgery π² Urology π² Vascular Surgery π² Other:________________________ |
Total Years of Post-Fellowship Clinical Practice
Experience: |
|
Work Environment: | π² Community facility
π² Primary health center π² First-level hospital π² Second-level hospital π² Third-level hospital |
Total Years of Residency and Fellowship Training Completed: | |
Clinical Skill To Be Tested: | Modular External Fixation of an Open Tibial Shaft Fracture |
Amount of Experience or Training With Modular External Fixation of an Open Tibial Shaft Fracture To Date: |
For this pre-learning clinical confidence assessment, please rate your responses from 1-5, with 1 being βDisagreeβ to 5 being βAgree.
Cognitive | |||||||
I know how to perform modular external fixation of an open tibial shaft fracture. | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
I understand the content of modular external fixation of an open tibial shaft fracture and can demonstrate it to others. | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
I can verbally explain the purpose and principle of operating modular external fixation of an open tibial shaft 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 modular external fixation of an open tibial shaft fracture. | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
I can smoothly complete the operation steps of modular external fixation of an open tibial shaft fracture. | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
I can monitor my modular external fixation of an open tibial shaft fracture for improvements | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
I can monitor my modular external fixation of an open tibial shaft fracture operations 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
Attachment C. Post-Learning Clinical Confidence Assessment[edit | edit source]
Learner Identification | |
---|---|
Date of Assessment (Year-Month-Day): | |
Name (First Name, Last Name): | |
De-Identified Unique Study Code for Learner: | |
Age (years): | |
Gender: | π² Male
π² Female π² Non-Binary |
Country of Practice: | |
Contact Information (email): | |
Country Code + Phone Number: |
|
π² Clinician Status: | π² Resident
π² Attending Physician π² Attending Surgeon |
Discipline/Specialty: |
π² Medical Officer (Non-Specialist Physician) π² General Surgery π² Neurological Surgery π² Obstetrics and Gynecology π² Ophthalmic Surgery π² Oral and Maxillofacial Surgery π² Otolaryngology π² Pediatric Surgery π² Plastic and Reconstructive Surgery π² Thoracic Surgery π² Urology π² Vascular Surgery π² Other:________________________ |
Total Years of Post-Fellowship Clinical Practice
Experience: |
|
Work Environment: | π² Community facility
π² Primary health center π² First-level hospital π² Second-level hospital π² Third-level hospital |
Total Years of Residency and Fellowship Training Completed: | |
Clinical Skill To Be Tested: | Modular External Fixation of an Open Tibial Shaft Fracture |
Amount of Experience or Training With Modular External Fixation of an Open Tibial Shaft Fracture To Date: | |
Amount of Experience or Training With Modular External Fixation of an Open Tibial Shaft Fracture 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 βDisagreeβ to 5 being βAgree.β
Cognitive | |||||||
I know how to perform modular external fixation of an open tibial shaft fracture. | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
I understand the content of modular external fixation of an open tibial shaft fracture and can demonstrate it to others. | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
I can verbally explain the purpose and principle of operating modular external fixation of an open tibial shaft 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 modular external fixation of an open tibial shaft fracture. | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
I can smoothly complete the operation steps of modular external fixation of an open tibial shaft fracture. | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
I can monitor my modular external fixation of an open tibial shaft fracture for improvements | Disagree | 1 | 2 | 3 | 4 | 5 | Agree |
I can monitor my modular external fixation of an open tibial shaft fracture operations 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.0209155