SELF EVALUATION
VASCULAR TECHNOLOGY
SKILLS PROFICIENCY CHECKLIST

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If you prefer, you can print a form to fax or mail.
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     Last Name: 
    First Name: 
Middle Initial: 
 Years Experience

DIRECTIONS: Place an x in the box that best describes your level of proficiency for each of the skills presented.

LEVELS OF PROFICIENCY KEY:

HP =

Highly Proficient.
Extensively experienced; able to supervise and/or train others.

 SE =

Some Experience.
Need review and assistance or supervision.
VE =

Very Experienced.
Can perform well without assistance or supervision.

 NE = No Experience.
EX =

Experienced.
Competent; can perform independently; may need initial review or supervision.
PROFICIENCY LEVEL
VASCULAR SKILLS: HP VE EX SE NE
Carotids
Plethysmography
Abdominal Aorta
Hepatic
Splenic
Resistive Index
Pulsatility Index
SMA
Renals
Segmental Pressures
TCD
Area for Percent Stenosis  
Diameter for Percent Stenosis  
PW/CW for Percent Stenosis  
PVR  
IPG  
Abdominal Doppler  
Penile Doppler  
Venous Duplex: Lower Extremities  
Venous Duplex: Upper Extremities  
Arterial Doppler: Lower Extremities  
Arterial Doppler: Upper Extremities  
OTHER AREAS OF SKILL: HP VE EX SE NE
EQUIPMENT USED: HP VE EX SE NE  
 
 
 
 
 
  
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