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
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
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SUBSPECIALTY TRAINEES
Name of Trainee…………………………………………
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]
SIX-MONTHLY TRAINING SUMMARY
REPORT OF RESEARCH PROGRESS(this must be completed at the end of each six months of research training)
Name of Trainee…………………………………………
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
Assisted Performed supervised
Performed unsupervised
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)
Assisted Performed supervised
Performed unsupervised
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
Occasional major lapse or frequent
minor lapse
few, or occasional lapses
no significant lapses above average, confident
an example to others
Effectiveness and Leadership in dealing with subordinates
Occasional major lapse or frequent
minor lapse
few, or occasional lapses
no significant lapses above average, confident
an example to others
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
passive occasionally initiates
initiating without prompting
coordinates departmental
activities
leads departmental activities
Responsibility and initiative in research
passive occasionally initiates
initiating without prompting
coordinates departmental
activities
leads departmental 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(
rudimentary, still needs improvement
meets subspecialty objectives
exceeds subspecialty objectives
authoritative
Medical andrology rudimentary, still needs improvement
meets subspecialty objectives
exceeds subspecialty objectives
authoritative
Assisted conception rudimentary, still needs improvement
meets subspecialty objectives
exceeds subspecialty objectives
authoritative
Female reproductive surgery (general)
rudimentary, still needs improvement
meets subspecialty objectives
exceeds subspecialty objectives
authoritative
Female reproductive surgery (endoscopic)
rudimentary, still needs improvement
meets subspecialty objectives
exceeds subspecialty
objectives
authoritative
Surgical andrology/ urology
rudimentary, still needs improvement
meets subspecialty objectives
exceeds subspecialty objectives
authoritative
Laboratory research skills relative to the treatise
undeveloped developing established advanced authoritative
Laboratory skills(assisted conception and andrology)
rudimentary, still needs improvement
meets subspecialty objectives
exceeds subspecialty objectives
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]