REI TAR.doc

The Royal Australian and New Zealand

College Of Obstetricians

and Gynaecologists

TRAINING ASSESSMENT RECORD FORREPRODUCTIVE ENDOCRINOLOGY & INFERTILITY SUBSPECIALTY TRAINING

NAME ........................................................................................................

ADDRESS...................................................................................................

.....................................................................................................................

.....................................................................................................................

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TELEPHONE..............................................................................................

TRAINING ASSESSMENT RECORD BOOK

Function of the Training Assessment Record Book

The Training Assessment Record Book has been designed to enable Trainees to record a summary of all necessary training and assessment experiences required for the relevant RANZCOG Training Program specifically for assessment purposes.

The Training Assessment Record is a facility for Trainees to record consecutively the many aspects that comprise the training program being undertaken so that State Training and Accreditation Committee Chairmen/Program Directors and Subspecialty Committees will be able to assess a Trainee’s progress relevant to the requirements of the Training Program and the training experiences previously recorded at the end of each six-month training period.

The Training Assessment Record will be forwarded to the Training Supervisor/Program Director/Subspecialty Committee at the end of each six-month training period for assessment.

Trainees will not be issued with a new Training Assessment Record each year. The book will need to be kept by the Trainee for the duration of the Training Program being completed. Additional pages for the Training Assessment record will be available upon request.

Please contact staff in the Subspecialties Section at College House, Melbourne on 03 9417 1699 if you have any questions

TRAINEE TRAINING RECORD

Name of Trainee:…………………………………….Training

YearTraining Institution Type of training

(see below)Dates for

commencement and completion of training

Total number of months training

Key to Type of TrainingITP: Integrated Training Program (Please write the name of the Integrated Training program such as ‘Monash Medical Centre’.GEN: General Obstetrics and GynaecologyRES: Research (100%)RES/CLIN: Combined research and clinical position, please give percentage of eachSUB: Subspecialty Training, please state CREI/COGUS/CGO/CU/CMFMELECT/OTHER: Please describe the nature of the Elective or Special training that has been prospectively approved.

WEEKLY TIMETABLE(for all RANZCOG Trainees and Subspecialty Trainees)

The Weekly Timetable is for recording a typical weekly timetable of activities for the type of training being completed.

If there was a significant change in the training program during the six-month period, please indicate this by producing an additional Weekly timetable for the period.

** Please photocopy this page as necessary.

Name of Trainee:…………………………………………………….

Day of the week Morning AfternoonMonday

Tuesday

Wednesday

Thursday

Friday

TRAINEE PARTICIPATION IN OTHER PROFESSIONAL ACTIVITIES

RANZCOG TRAINEES

Name of Trainee…………………………………………

Meetings attended outside the training institution

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

SUBSPECIALTY TRAINEES


Meetings attended related to the Subspecialty

Date Venue Topic

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Scientific presentations made

Date Venue Topic____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

THE ROYAL AUSTRALIAN & NEW ZEALAND COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS

MID-SEMESTER FORMATIVE ASSESSMENT - CONFIDENTIAL

NAME OF TRAINEE:................................................................................................

HOSPITAL:................................................................ STATE:........................

IMPORTANT NOTES

This mid-semester assessment of the trainee’s knowledge, skills and attitudes is a COMPULSORY assessment, which all Training Supervisors are required to complete for each REI trainee. The supervisor MUST discuss this assessment with the trainee.

Supervisor and trainee should retain copies of form for their records. Trainee sends assessment form to the REI Subspecialty Committee at College House

Report for the three months commencing / / and ending / /

Report for training year 1 2 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

TRAINEE’S ASSESSMENT OF PROGRESS & PERFORMANCE [Note: This section is to be completed by the trainee.]

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

SUPERVISOR’S ASSESSMENT OF TRAINEE’S PROGRESS & PERFORMANCE[Note: Assessment must be based in part on discussions with key consultants who have worked with the trainee.]

TRAINEE’S STRENGTHS:

AREAS FOR IMPROVEMENT:

SUMMARY OF PLAN FOR REMEDIAL ACTION (e.g. monthly meetings with trainee, closer supervision in specific areas, etc.)

…/ please complete following page

SATISFACTORY

SUPERVISOR: I have warned the trainee that improvement will be expected over the next three months in the areas specified above or an unsatisfactory six-month report may result [Supervisor to initial box]

TRAINEE: I have had the implications of this warning explained to me and I understand them [trainee to initial box]

Training Supervisor: (signature)........................................................................................Date:..........................................

* MY TRAINING SUPERVISOR HAS DISCUSSED THIS ASSESSMENT WITH ME

Trainee: ............................................................................................................................... Date:..............................

Chairman, REI Subspecialty Committee............................................................................ Date................................

CHECKLIST FOR COMPLETING THE MID-SEMESTER FORMATIVEASSESSMENT FORM

Information about the trainee and the exact dates of training period covered by form are filled in completely.

Sections relating to trainee’s AND supervisor’s assessment of trainee’s progress and performance are filled out.

Summary of plan for remedial action included (if required).

Training Supervisor has ticked relevant box indicating that assessment was satisfactory OR trainee has been warned that improvement is required.

If a warning given, trainee has ticked relevant box to indicate this.

Training Supervisor has printed their name and signed/dated report.

Report has been discussed with trainee and signed/dated by trainee.

Once the trainee and the Training Supervisor have signed the report, the TRAINEE is responsible for IMMEDIATELY submitting the assessment form for checking/signing by the relevant Subspecialty Chair at College House.

Original of signed assessment form is processed and goes into the trainee’s file at College

House. A signed copy is sent to the trainee.

FOR ANY QUERIES RELATING TO TRAINING PLEASE CONTACT:

Subspecialties SectionTraining Services Department at College HousePhone: +61 3 9417 1699 Fax: +61 3 9419 7817Email: [email protected]

mailto:[email protected]

SIX-MONTHLY TRAINING SUMMARY

REPORT OF RESEARCH PROGRESS(this must be completed at the end of each six months of research training)


Trainee Research Progress Report for the six-month period ____________ to _____________

Please describe the progress made during this period against the goals set for the same.

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Signed and dated______________________________________________________________

Research Progress Report from the Training Supervisor

Please comment on the Trainee’s progress against the goals set for the period and the expected skill level of a Trainee at that level

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Signed and dated______________________________________________________________

Reproductive Endocrinology and Infertility

SIX-MONTH CLINICAL TRAINING SUMMARY

Name: Dates:

Female reproductive Medicine

Assisted Performed supervised

Performed unsupervised

Supervised others

TOTAL this

period

CUMULATIVE TOTAL

Ovulation induction with clomipheneOvulation induction with follicle stimulating hormoneOvulation induction with pulsatile GnRHOvarian suppression with Oral contraceptives or other steroid combinationsOvarian suppression with GnRH agonists or antagonistsHormone replacement therapyAnti-androgen therapy

General Endocrinology casesPuberty/adolescent gynaecologyFamily Planning (contraceptive) casesNeuro-endocrinology cases

Female reproductive surgeryTubal micro-surgery

Tubal reversal (microsurgical anastomosis)Benign adnexal surgery (ovarian cystectomies etc)Myomectomy (laparotomy)

Metroplasty (Laparotomy)

Hysteroscopic Polypectomy

Hysteroscopic Myomectomy

Hysteroscopic division of adhesionsHysteroscopic matroplasty (septoplasty)Laparoscopic assisted hysterectomyLaparoscopic excision adnexal tissueLaparoscopic excision extensive endometriosisTotal abdominal Hysterectomy/bilateral salpingo-oopherectomy

Andrology and male reproductive surgery



Supervised others

TOTAL this

period

CUMULATIVE TOTAL

Male factor (male infertility ) casesDiagnostic andrology cases (non-infertility)Diagnostic Urology cases

Male Hormone replacement TherapyVasectomy reversal

Microsurgical epididymal sperm aspirationTesticular sperm or spermatid extractionTesticular Biopsy

Assisted Conception

Laporoscopic egg pick-up (do not code in addition to LAP-GIFT)Laparoscopic Gamete Intrafallopian TransferLaporoscopic zygote (or pre-embryo) intrafallopian transferTransvaginal egg pick-up (do not include in addition to LAP-GIFT)Transvaginal gamete intrafallopian transferTransvaginal zygote (or pre-embryo) intrafallopian transferUterine embryo transfer

Imaging

Diagnostic Laparoscopy (+/- minor intervention)Diagnostic Hysteroscopy

Falloposcopy

Salpingoscopy

Hysterosalpingogram

Ultrasound follicle tracking

Diagnostic ultrasound

CT Scan (interpretation with radiologist)



Supervised others

TOTAL this

period

CUMULATIVE TOTAL

MRI scan (interpretation with radiologist)

Laboratory SkillsSessions in an immuno-assay laboratorySemen analysis

Sperm preparation

procedures

IVF procedures

IVF fertilisation checks

ICSI procedures

Embryo freezing procedures

Polymeras chain reaction proceduresFluorescent in-situ hybridisation proceduresTransmission electron microscopy examinationsScanning electron microscopy examinationsResearchHalf days spent on research projects

SUMMARY OF SURGICAL EXPERIENCE (trainee MUST complete the cumulative total column every six months or form will be returned for completion)

THE ROYAL AUSTRALIAN & NEW ZEALAND COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS

REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITYSIX-MONTHLY TRAINEE REPORT - CONFIDENTIAL

NAME OF TRAINEE:

TRAINING UNIT: YEAR OF S/S TRAINING:

REPORT FOR THE SIX MONTHS COMMENCING / / AND ENDING / / .

Instructions:

ConsultantsPlease indicate where you assess the Trainee is performing for each of the following domains. Please note, the reference to Stages is to encourage you to consider the absolute stage of development the Trainee is at with respect to the domain rather than relative to the Subspecialty Training year the Trainee is undertaking. Please place a tick in the box that best describes the Trainee’s present performance in the domain. Consultants are also asked to complete the Trainee strengths and weaknesses section.Training SupervisorsPlease collate the responses from the consultants (at least three) and also complete the section confirming the training period as satisfactory or unsatisfactory.

Professionalism Stage 1 Stage 2 Stage 3 Stage 4 Stage 5

Effectiveness and Compassion in dealing with patients and relatives

Occasional major lapse or frequent

minor lapse

few, or occasional lapses

no significant lapses above average, confident

an example to others

Effectiveness and cooperation in dealing with peers


minor lapse




Effectiveness and Leadership in dealing with subordinates


minor lapse




General Subspecialty AchievementResponsibility and initiative in clinical care, especially quality management and outcomes review

passive occasionally initiates

initiating without prompting

coordinates departmental

activities

leads departmental activities

Responsibility and initiative in teaching




activities


Responsibility and initiative in research




activities


Publications submitted, in press, or published (indicate status):

Specific Subspecialty AchievementPlease note: These domains record absolute levels achieved and are not to be relative to the stage of training. The Subspecialty Committee will monitor progress

Female reproductive Endocrinology

rudimentary, still needs improvement

meets subspecialty objectives

exceeds subspecialty objectives

authoritative

General endocrinology (including neuro endocrinology(




authoritative

Medical andrology rudimentary, still needs improvement



authoritative

Assisted conception rudimentary, still needs improvement



authoritative

Female reproductive surgery (general)




authoritative

Female reproductive surgery (endoscopic)



exceeds subspecialty

objectives

authoritative

Surgical andrology/ urology




authoritative

Laboratory research skills relative to the treatise

undeveloped developing established advanced authoritative

Laboratory skills(assisted conception and andrology)




authoritative

(completed by consultants and collated by Training Supervisor)STRENGTHS OF TRAINEE

WEAKNESS OF TRAINEE

Trainee.............................................................................................Date....................................

The Royal Australian and New Zealand

College Of Obstetricians

and Gynaecologists

Name of Trainee: Year Level:

Hospital: Name of Training Supervisor:

Report for the six months from: ____/____/_____ to: ____/____/____

Full-Time Part-Time Hours Per Week _________

ATTRIBUTEVery Good Pass Border-line Fail Insufficient

Female reproductive Endocrinology

General endocrinology (including neuro endocrinology)

Medical andrology

Assisted conception

Female reproductive surgery (general)

Female reproductive surgery (endoscopic)

Surgical andrology/ urology

Laboratory research skills relative to the treatise

Laboratory skills(assisted conception and andrology)

Effectiveness and Compassion in dealing with patients and relativesEffectiveness and cooperation in dealing with peersEffectiveness and Leadership in dealing with subordinatesResponsibility and initiative in clinical care, especially quality management and outcomes reviewResponsibility and initiative in teachingResponsibility and initiative in research

TRAINING SUPERVISOR’S ASSESSMENT OF TRAINEE’S PROGRESS & PERFORMANCEAssessment must be based on discussions with key consultants who have worked with the trainee.Trainee’s Strengths:

Areas For Improvement:

Training Supervisor Signature: Date: _____________

My Training Supervisor has discussed this assessment with me

Trainee Signature: Date: _____________

THIS REPORT HAS BEEN ASSESSED AS:SATISFACTORY BORDERLINE (Following review by REI Subspecialty Committee) FAIL (Following review by REI Subspecialty Committee)

REI CHAIR SIGNATURE: Date:

THE OVERALL PERFORMANCE OF THE TRAINEE IN THIS SIX MONTH PERIOD HAS BEEN:SATISFACTORY

ORREFERRED TO REI SUBSPECIALTY COMMITTEE FOR REVIEW

REI SIX-MONTHLY SUMMATIVE ASSESSMENT REPORT - CONFIDENTIAL

Leave taken in this 6-mth period: ______ wksLeave type(s): _________________________

Name of Trainee: Year Level:

Hospital: Name of Training Supervisor:

Report for the six months from: ____/____/_____ to: ____/____/____

Full-Time Part-Time Hours Per Week _________

REI SIX-MONTHLY SUMMATIVE ASSESSMENT REPORT - CONFIDENTIAL

Leave taken in this 6-mth period: ______ wksLeave type(s): _________________________

GUIDELINES FOR THE ITP SIX-MONTHLY SUMMATIVE ASSESSMENT REPORT

COMPLETING THE REPORT

For each attribute, indicate the number of consultants who give each rating.o eg. 5 consultants assess the trainee. For the attribute, Responsibility and initiative: 2 give a rating of PASS; 3 rate the

trainee as BORDERLINE. This information should be recorded as follows:

ATTRIBUTEVery Good

PassBorder-line

FailInsuff-icient

1. Responsibility and initiative 2 3

Training Supervisor and trainee must meet to discuss the report. Training Supervisor and trainee both sign and date the report.

TIMING OF THE REPORT

2-3 WEEKS BEFORE THE END OF THE TRAINEE’S SIX-MONTH PERIOD OF TRAINING:o Distribute copies of the Consultant Assessment of Trainee form to the relevant consultants.o Both Training Supervisor and trainee need to be aware of the end date of the training period.

AT THE END OF THE SIX-MONTH PERIOD OF TRAINING:o The Training Supervisor must compile the report and discuss this with the trainee.o When a trainee will undertake their following period of training at a different hospital, it is important that the report is

completed before the trainee leaves their current hospital. 8 WEEKS AFTER THE END OF THE SIX-MONTH PERIOD OF TRAINING:

o The Six-monthly Report must be submitted by the trainee to the relevant subspecialty Chair no later than the deadline. Trainees are notified of the relevant deadlines at the beginning of each training year.

UNSATISFACTORY REPORTS

A report is NOT SATISFACTORY if:o A FAIL is recorded in ANY attribute. o Half, or a majority, of the consultants assess a trainee as BORDERLINE in THREE OR MORE attributes.

If a report is NOT SATISFACTORY:o The Training Supervisor MUST refer the report, along with the Training Assessment Record (TAR), to the relevant

subspecialty committee for review.o The relevant subspecialty committee meets to discuss the report and decide whether it will be assessed as

SATISFACTORY, BORDERLINE or FAIL.o The relevant subspecialty Chair informs the trainee and the Training Supervisor of the decision.o The trainee is provided with a copy of the report.o If a trainee receives THREE consecutive reports assessed as FAIL during the course of their training,

the trainee will be removed from the program.

The REI Six-monthly Summative Assessment Report is to be completed by the Training Supervisor to assess the trainee’s competence as a clinician. It is a collation of the feedback provided by consultants who have worked with the trainee in the six-month period of training. It is the Training Supervisor’s responsibility to collect this information from the consultants.

WHEN THE REPORT IS COMPLETE

If the report is SATISFACTORY:o After the Training Supervisor and the trainee have signed the report, the TRAINEE is responsible for submitting the

report to the REI Subspecialty Chair at College House, along with their TAR and Clinical Training Summaries (CTS).. If the report is NOT SATISFACTORY:

o After the Training Supervisor and the trainee have signed the report the TRAINING SUPERVISOR refers the report and TAR to the REI Subspecialty Committee for review.

FOR ANY QUERIES RELATING TO TRAINING PLEASE CONTACT:Subspecialties Department at College HousePhone: +61 3 9417 1699Fax: +61 3 9417 7817Email: [email protected]

mailto:[email protected]

REI TAR.doc

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