REI TAR.doc

The Royal Australian and New Zealand College Of Obstetricians and Gynaecologists TRAINING ASSESSMENT RECORD FOR REPRODUCTIVE ENDOCRINOLOGY & INFERTILITY SUBSPECIALTY TRAINING NAME ........................................................................................................ ADDRESS.................................................................................................. ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... 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 Training Institution Type of training Dates for Total number Year (see below) commencement and of months completion of training training Key to Type of Training ITP: Integrated Training Program (Please write the name of the Integrated Training program such as ‘Monash Medical Centre’. GEN: General Obstetrics and Gynaecology RES: Research (100%) RES/CLIN: Combined research and clinical position, please give percentage of each SUB: Subspecialty Training, please state CREI/COGUS/CGO/CU/CMFM ELECT/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 Afternoon Monday Tuesday Wednesday Thursday Friday

TRAINEE PARTICIPATION IN OTHER PROFESSIONAL ACTIVITIES RANZCOG TRAINEES Name of Trainee………………………………………… Meetings attended outside the training institution _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ 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 1Ì 2Ì 3Ì - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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 u SATISFACTORY

u 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] u 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 FORMATIVE ASSESSMENT 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 Section Training Services Department at College House Phone: +61 3 9417 1699 Fax: +61 3 9419 7817 Email: fgilleard@ranzcog.edu.au

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: Assisted Performed Performed Supervised TOTAL CUMULATIVE Female reproductive supervised unsupervised others this TOTAL Medicine period Ovulation induction with clomiphene Ovulation induction with follicle stimulating hormone Ovulation induction with pulsatile GnRH Ovarian suppression with Oral contraceptives or other steroid combinations Ovarian suppression with GnRH agonists or antagonists Hormone replacement therapy Anti-androgen therapy General Endocrinology cases Puberty/adolescent gynaecology Family Planning (contraceptive) cases Neuro-endocrinology cases Female reproductive surgery Tubal micro-surgery Tubal reversal (microsurgical anastomosis) Benign adnexal surgery (ovarian cystectomies etc) Myomectomy (laparotomy) Metroplasty (Laparotomy) Hysteroscopic Polypectomy Hysteroscopic Myomectomy Hysteroscopic division of adhesions Hysteroscopic matroplasty (septoplasty) Laparoscopic assisted hysterectomy Laparoscopic excision adnexal tissue Laparoscopic excision extensive endometriosis Total abdominal Hysterectomy/bilateral salpingo-oopherectomy Assisted Performed Performed Supervised TOTAL CUMULATIVE Andrology and male supervised unsupervised others this TOTAL reproductive surgery period Male factor (male infertility )

cases Diagnostic andrology cases (non-infertility) Diagnostic Urology cases Male Hormone replacement Therapy Vasectomy reversal Microsurgical epididymal sperm aspiration Testicular sperm or spermatid extraction Testicular Biopsy Assisted Conception Laporoscopic egg pick-up (do not code in addition to LAP- GIFT) Laparoscopic Gamete Intrafallopian Transfer Laporoscopic zygote (or pre- embryo) intrafallopian transfer Transvaginal egg pick-up (do not include in addition to LAP-GIFT) Transvaginal gamete intrafallopian transfer Transvaginal zygote (or pre- embryo) intrafallopian transfer Uterine embryo transfer Imaging Diagnostic Laparoscopy (+/- minor intervention) Diagnostic Hysteroscopy Falloposcopy Salpingoscopy Hysterosalpingogram Ultrasound follicle tracking Diagnostic ultrasound CT Scan (interpretation with radiologist) Assisted Performed Performed Supervised TOTAL CUMULATIVE supervised unsupervised others this TOTAL period MRI scan (interpretation with radiologist) Laboratory Skills Sessions in an immuno-assay laboratory Semen analysis Sperm preparation procedures

IVF procedures IVF fertilisation checks ICSI procedures Embryo freezing procedures Polymeras chain reaction procedures Fluorescent in-situ hybridisation procedures Transmission electron microscopy examinations Scanning electron microscopy examinations Research Half 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 INFERTILITY SIX-MONTHLY TRAINEE REPORT - CONFIDENTIAL NAME OF TRAINEE: TRAINING UNIT: YEAR OF S/S TRAINING: REPORT FOR THE SIX MONTHS COMMENCING / / AND ENDING / / . Instructions: Consultants Please 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 Supervisors Please 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 Occasional major few, or occasional no significant lapses above average, an example to others Compassion in dealing lapse or frequent lapses confident with patients and minor lapse relatives Effectiveness and Occasional major few, or occasional no significant lapses above average, an example to others cooperation in dealing lapse or frequent lapses confident with peers minor lapse Effectiveness and Occasional major few, or occasional no significant lapses above average, an example to others Leadership in dealing lapse or frequent lapses confident with subordinates minor lapse General Subspecialty Achievement Responsibility and passive occasionally initiating without coordinates leads departmental initiative in clinical initiates prompting departmental activities care, especially quality activities management and outcomes review Responsibility and passive occasionally initiating without coordinates leads departmental initiative in teaching initiates prompting departmental activities activities Responsibility and passive occasionally initiating without coordinates leads departmental initiative in research initiates prompting departmental activities activities Publications submitted, in press, or published (indicate status):

Specific Subspecialty Achievement Please 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 rudimentary, still needs meets subspecialty exceeds subspecialty authoritative Endocrinology improvement objectives objectives General endocrinology rudimentary, still needs meets subspecialty exceeds subspecialty authoritative (including neuro improvement objectives objectives endocrinology( Medical andrology rudimentary, still needs meets subspecialty exceeds subspecialty authoritative improvement objectives objectives Assisted conception rudimentary, still needs meets subspecialty exceeds subspecialty authoritative improvement objectives objectives Female reproductive rudimentary, still needs meets subspecialty exceeds subspecialty authoritative surgery (general) improvement objectives objectives Female reproductive rudimentary, still needs meets subspecialty exceeds subspecialty authoritative surgery (endoscopic) improvement objectives objectives Surgical andrology/ rudimentary, still needs meets subspecialty exceeds subspecialty authoritative urology improvement objectives objectives Laboratory research undeveloped developing established advanced authoritative skills relative to the treatise Laboratory skills rudimentary, still needs meets subspecialty exceeds subspecialty authoritative (assisted conception improvement objectives objectives and andrology) (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 REI SIX-MONTHLY SUMMATIVE ASSESSMENT REPORT - CONFIDENTIAL Name of Trainee: Year Level: Hospital: Name of Training Supervisor: Report for the six months from: ____/____/_____ to: ____/____/____ Leave taken in this 6-mth period: ______ wks Leave type(s): _________________________ Full-Time  Part-Time  Hours Per Week _________ ATTRIBUTE Very 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 relatives Effectiveness and cooperation in dealing with peers Effectiveness and Leadership in dealing with subordinates Responsibility and initiative in clinical care, especially quality management and outcomes review Responsibility and initiative in teaching Responsibility and initiative in research TRAINING SUPERVISOR’S ASSESSMENT OF TRAINEE’S PROGRESS & PERFORMANCE Assessment must be based on discussions with key consultants who have worked with the trainee. Trainee’s Strengths: Areas For Improvement: THE OVERALL PERFORMANCE OF THE TRAINEE IN THIS SIX MONTH PERIOD HAS BEEN: SATISFACTORY  OR REFERRED TO REI SUBSPECIALTY COMMITTEE FOR REVIEW  Training Supervisor Signature: Date: _____________ My Training Supervisor has discussed this assessment with me THIS REPORT HAS BEEN ASSESSED AS: Trainee Signature: SATISFACTORY  _____________ Date: BORDERLINE (Following review by REI Subspecialty Committee)  FAIL (Following review by REI Subspecialty Committee)  REI CHAIR SIGNATURE: Date:

GUIDELINES FOR THE ITP SIX-MONTHLY SUMMATIVE ASSESSMENT REPORT 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. 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: Very Border- Insuff- ATTRIBUTE Pass Fail Good line 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. 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 SUMMATIVE ASSESSMENT REPORT - CONFIDENTIALthe report REI SIX-MONTHLY and the trainee have signed the report the TRAINING SUPERVISOR refers and TAR to the REI Subspecialty Committee for review. Name of Trainee: Year Level: FOR ANY QUERIES RELATING TO TRAINING PLEASE CONTACT: Hospital: Subspecialties Department at College House Name of Training Supervisor: Phone: +61 3 9417 1699 Report for the six months from: ____/____/_____ to:9417 7817 Fax: +61 3 ____/____/____ Leave taken in this 6-mth period: ______ wks Email: training@ranzcog.edu.au Leave type(s): _________________________

Full-Time  Part-Time  Hours Per Week _________

REI TAR.doc

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