MEDICAL PROCEDURES PRACTICAL EXAM EVALUATION FORM 2001
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1 MEDICAL PROCEDURES PRACTICAL EXAM EVALUATION FORM 2001 STUDENT NAME: Station One: Sterile Technique and Skin Preparation Instructor: Nelson Kraus Syringes with needles Alcohol pads Water in multi-dose vials Surgical masks Sterile gloves Drapes One or two random surgical instruments Basin with tap water Betadine swabs Y N The student adequately demonstrated appropriate masking technique. Y N The student adequately demonstrated appropriate sterile gloving technique. Y N The student adequately demonstrated appropriate draping technique. Y N The student adequately demonstrated appropriate handling of sterile instruments within a sterile field. Y N The student adequately demonstrated appropriate technique in drawing up sterile solutions into a syringe. Y N The student adequately demonstrated appropriate wound cleansing techniques with both Betadine cleanser and irrigation.
2 Station Two: Anesthesia and Hand Ties Instructor: John Lucich Syringes with needles Alcohol pads Water in multi-dose vials Ligatures Suture board (or equivalent to perform hand ties) Y N The student adequately demonstrated appropriate technique in the administration of anesthetic including local, field and nerve blocks. Y N The student was able to place 5 knots in one minute using the surgeon s knot technique.
3 Station Three: Biopsy and Cryosurgery Instructor: Michel Schultz Punch biopsy instrument Forceps Tissue scissors Liquid nitrogen Cotton tipped applicators Y N The student adequately demonstrated appropriate technique for cryosurgery and was knowledgeable of the indications, contraindications, patient education needs and complications associated with this procedure. Y N The student adequately demonstrated appropriate technique for a shave biopsy and was knowledgeable of the indications, contraindications, patient education needs and complications associated with this procedure. Y N The student adequately demonstrated appropriate technique for a punch biopsy and was knowledgeable of the indications, contraindications, patient education needs and complications associated with this procedure.
4 Station Four: I&D and Chest Tube Instructor: Jennifer Holycross-Welch Large clamp Chest tube Angiocath Inch wide gauze strips (to simulate Iodophor packing) Y N The student adequately demonstrated appropriate I&D technique and was knowledgeable of the indications, contraindications, patient education needs and complications associated with this procedure. Y N The student adequately demonstrated appropriate technique for packing an abscess cavity. Y N The student adequately demonstrated appropriate technique for needle thoracostomy and was knowledgeable of the indications, contraindications, patient education needs and complications associated with this procedure. Y N The student adequately demonstrated appropriate technique for tube thoracostomy and was knowledgeable of the indications, contraindications, patient education needs and complications associated with this procedure. Instructor Initial:
5 Station Five: Undermining and Laceration Repair Instructor: Chuck Nagel Skin suture with attached curved needle Needle holder Forceps Scissors Y N The student adequately demonstrated appropriate application of wound undermining. Y N The student was able to place 2 sutures in sixty seconds using a standard instrument tie.
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