Authentic Assessment Instrument

PIDP 3230 – Evaluation of Learning
Vancouver Community College
Kathryn Truant
June 26, 2017

Oral & Maxillofacial Surgery Module for Certified Dental Assistants (CDA’s): Unit One – The Perioperative Period
Clinical Performance Assessment

Student Name: ______________________
Observer Name: _____________________
Student Number: __________________
Date: ___________ Attempt Number: __________
Instructor: Kathryn Truant CDA

 Introduction and Instructions – Please Read Carefully

Criteria of Assessment:

The Certified Dental Assistant will re-enact the clinical outcomes of the Oral and Maxillofacial Surgery Perioperative Period (Unit One) in a simulated clinical environment following the instructor’s demonstration using the checklist provided (please obtain two copies).  The time limit to complete the assessment is one hour.

Observation of Assessment:

Following the demonstration, students will be assigned an operatory and divided into groups of three. Each student will take turns completing the checklist in SEQUENTIAL ORDER. Indication of performance will be documented as a Yes or No. Each student will conduct a self-assessment, and a peer assessment.

Value of Assessment: Course Value = 10%

All items on the checklist MUST be completed for the student to PASS the Clinical Performance Assessment of Unit One – The Perioperative Period. The number of attempts to successfully complete the checklist is TWO. Not completing the checklist after two attempts will result in a failure of the clinical portion of Unit One.

Clinical Performance Assessment Checklist:

Oral & Maxillofacial Surgery Module for CDA’s:

Unit One – The Perioperative Period

Performance to be Assessed
Performance Observed
The Preoperative Phase    
1. Organize health records and radiographs
2. Confirm operatory set-up
3. Address patient by first and last name upon intake: confirm identity
4. Review health history: confirm known allergies (e.g. latex)
5. Review health history: confirm special precautions (e.g. diabetes)
6. Confirm NPO status
7. Confirm that a responsible adult is in attendance: for minor consent and discharge
8. Obtain patient’s weight: for anesthetist
9. Ensure that patient/guardian knows what is going to happen: procedure
10. Obtain surgical consent
11. Secure patient’s personal affects
            The Intraoperative Phase
12. Position patient
13. Obtain baseline vital signs
14. Perform Surgical Time Out: patient, procedure, verbal consent
15. Confirm sterility of operatory
16. Drape patient
17. Support airway
18 Maintain operating field: transfer instruments, light, retract, suction
19. Ensure that patient is comfortable and dignity maintained
20. Document vital signs for transfer to recovery
           The Postoperative Phase
21. Remain with patient: Check ABC’s
22. Give verbal and written postoperative instructions to patient and responsible adult
23. Organize prescriptions
24. Update patient’s treatment records
25. Discharge patient

Checklist Complete: Yes____ No____     Initials: Observer ____ Student: ____

Comments to Student:


Comments to Observer (or Instructor):