CLINICAL EXPERIENCE AND LOGBOOK

NAME:

/

NTN:

NAME:
YEAR OF TRAINING CT/ST/LAT:
BASEHOSPITAL:
DATE OF LAST SUBMISSION:
DATE OF CURRENT SUBMISSION:
NTN: / CCT DATE
(if known):
FULL TIME/LTFT:
GMC No. / REG. (Full/Limited):
E-mail:
Contact Address:
QUALIFICATIONS
UNIVERSITY DEGREE
(MB ChB, BSc etc)
POSTGRADUATE EXAMS
(Non Anaesthetic)
ANAESTHETIC EXAMS
(Please include unsuccessful attempts at Primary or Final parts if you currently have not obtained a pass)

CLINICAL EXPERIENCE

Please record your clinical experience in chronological order beginning with Foundation year 1.

In anaesthesia you should include all rotations to other hospitals and all rotations within base hospital (e.g. ICU, Obstetrics).

Dates of rotations for CT/ST/LAT training MUST include Day/Month/Year for the beginning and end of each rotation (i.e. dd/mm/yy – dd/mm/yy).

ST 5 - 7 trainees, please clearly identify which rotations are higher and which are advanced.

There should be no gaps so detail all periods of sick leave, maternity leave or phased return to work periods. Please indicate if LTFT.

Please put in bold type rotations undertaken since last review

DATES
(dd/mm/yy - dd/mm/yy) / HOSPITAL / GRADE
(+/- LTFT%) / SPECIALTY / ROTATION

LOGBOOK

Provide a summary of your logbook data. Include thetotal number of casesandthenumber in which you were directly supervised (i.e. senior help immediately available) for each anaesthetic subspecialty.

Each year you should supply 2 separatelogbook summaries:

1. ANNUAL LOGBOOK: what you have donesince your previous ARCP paper/e-portfolio submission.

2. CUMULATIVE LOGBOOK: all cases during CT/ST/LAT training.

Most of the information should be reproducible from the College log book butseparate data for Obstetrics, ITU and Pain experience is required.

ANNUAL LOGBOOK

Specialty / Total number of cases / Number with direct supervision
General
Orthopaedics / Trauma
Gynaecology
Urology
ENT
Ophthalmology
Vascular
Cardiac
Thoracic
Neuro
Maxillo-facial / Dental
Plastics / Burns
Paediatrics ( cases should notappear in other specialties )
Other ( specify )
Total

ANNUAL LOGBOOK

Case Mix Experience

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CLINICAL EXPERIENCE AND LOGBOOK

NAME:

/

NTN:

ASA / Total / Direct supervision
1
2
3
4
5
Priority / Total / Direct supervision
Elective
Urgent
Emergency
Total

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CLINICAL EXPERIENCE AND LOGBOOK

NAME:

/

NTN:

Total
Obstetric Anaesthesia Experience
Procedure / Total / With direct supervision
Epidural analgesia
Epidural LSCS
Spinal LSCS elective
Spinal LSCS urgent
GA LSCS
CSE
Others
Total cases
Intensive Care Medicine Experience
Rotation
Hospital/duration / Total no. admitted to unit / Admissions by you / Transfers / Crash calls
Total

Pain Management Experience - Acute

Total / With direct supervision
Acute Pain Rounds
New patients seen
Review patients seen

Pain Management Experience - Chronic

Total / With direct supervision
Out Patient Clinics
Number patients seen
Treatment sessions
Procedures performed
Multi-disciplinary meetings

ANNUAL LOGBOOK

Local Anaesthetic Blocks

/ Total / With direct supervision / Ultrasound guided
CSE (excl obstetrics)
Spinal (excl obstetrics)
Epidural- Lumbar (excl obstetrics)
Epidural-Thoracic
Caudal
Interscalene
Supraclavicular
Axillary
Wrist
Transversus Abdominal Plane
Inguinal
Femoral
Fascia-iliaca
Lumbar Plexus
Sciatic
Popliteal
Ankle
Eye Blocks
Cervical Plexus
Other (specify)

PROCEDURES

/ TOTAL / With direct supervision / Ultrasound guided
Internal Jugular Catheter
Subclavian catheter
Arterial Line
Bronchoscopy
Fibreoptic intubation (Awake)
Fibreoptic intubation (Asleep)
Cricothyroidotomy
Percutaneous Tracheostomy
Inhalational induction
TIVA
Double Lumen Tube
Cardio-pulmonary bypass
Chest drain insertion
Jet Ventilation
Videolaryngoscopy
PAIN Procedures (specify)
OTHER (specify)

CUMULATIVE LOGBOOK

Please include all cases throughout CT/ST/LAT training.

Specialty / Total number of cases / Number with direct supervision
General
Orthopaedics / Trauma
Gynaecology
Urology
ENT
Ophthalmology
Vascular
Cardiac
Thoracic
Neuro
Maxillo-facial / Dental
Plastics / Burns
Paediatrics (cases should notappear in other specialties)
Other (specify)
Total

CUMULATIVE LOGBOOK

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CLINICAL EXPERIENCE AND LOGBOOK

NAME:

/

NTN:

Case Mix Experience
ASA / Total / Direct supervision
1
2
3
4
5
Total
Priority / Total / Direct supervision
Elective
Urgent
Emergency
Total

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CLINICAL EXPERIENCE AND LOGBOOK

NAME:

/

NTN:

Obstetric Anaesthesia Experience
Procedure / Total / With direct supervision
Epidural analgesia
Epidural LSCS
Spinal LSCS elective
Spinal LSCS urgent
GA LSCS
CSE
Others
Total cases
Intensive Care Medicine Experience
Rotation
Hospital/duration / Total no. admitted to unit / Admissions by you / Transfers / Crash calls
Total

Pain Management Experience - Acute

Total / With direct supervision
Acute Pain Rounds
New patients seen
Review patients seen

Pain Management Experience - Chronic

Total
Out Patient Clinics
Number patients seen
Treatment sessions
Procedures performed
Multi-disciplinary meetings

CUMULATIVE LOGBOOK

Local Anaesthetic Blocks

/ Total / With direct supervision / Ultrasound guided
CSE (excl obstetrics)
Spinal (excl obstetrics)
Epidural – Lumbar (excl obs)
Epidural-Thoracic
Caudal
Interscalene
Supraclavicular
Axillary
Wrist
Transversus Abdominal Plane
Inguinal
Femoral
Fascia-iliaca
Lumbar Plexus
Sciatic
Popliteal
Ankle
Eye Blocks
Cervical Plexus
Other (specify)
Other (specify)
PROCEDURES / Total / With direct supervision / Ultrasound guided
Internal Jugular Catheter
Subclavian catheter
Arterial Line
Bronchoscopy
Fibreoptic intubation (Awake)
Fibreoptic intubation (Asleep)
Cricothyroidotomy
Percutaneous Tracheostomy
Inhalational induction
TIVA
Double Lumen Tube
Cardio-pulmonary bypass
Chest drain insertion
Jet Ventilation
Videolaryngoscopy
PAIN Procedures (specify)
OTHER (specify)

COMPLETION OF BASIC LEVEL ASSESSMENTS & UNITS OF TRAINING

Date (dd/mm/yyyy)
IAC Certificate
IACOA Certificate
Primary MCQ pass
PrimaryVivaPass
Primary OSCE pass
Basic Level Training Certificate

Insert dates of satisfactory assessments ( dd/mm/yy) :

A-CEX
or
ALMAT / DOPS / CBD / MISC. / COMPLETION OF UNIT OF TRAINING FORM
Airway Management
Critical Incidents
Day Surgery
Gen/Uro/Gyn
Head&Neck, Max-facial, Dental
ICM
Non-theatre
Obstetrics
Orthopaedics
Paediatrics
Pain Medicine
Regional
Sedation
Transfer Medicine
Trauma & Stabilisation

COMPLETION OF INTERMEDIATE LEVEL ASSESSMENTS & UNITS OF TRAINING

Date (dd/mm/yyyy)
Basic Level Training Certificate
Intermediate Level Training Certificate
date of entry to higher level training
Intermediate Level Progress Report
date of entry to higher level training
Final Written pass
Final Viva pass

Insert dates of satisfactory assessments ( dd/mm/yy ) :

ESSENTIAL
UNITS / A-CEX
or
ALMAT / DOPS / CBD / MISC. / COMPLETION OF UNIT OF TRAINING FORM
ICM
Obstetrics
Paediatrics
Neuro
Cardio-thoracic
Pain
Airway Management
Critical Incidents
Day Surgery
Gen/Uro/Gyn
Head & Neck, Max-facial, Dental
Resp/Cardiac Arrest
Non-theatre
Orthopaedics
Regional
Sedation
Transfer Medicine
Trauma & Stabilisation
OPTIONAL
UNITS / A-CEX
or
ALMAT / DOPS / CBD / MISC. / COMPLETION OF UNIT OF TRAINING FORM
Ophthalmic
Plastics/Burns
Vascular

COMPLETION OF HIGHER LEVEL ASSESSMENTS & UNITS OF TRAINING

date of entry to higher level training
(dd/mm/yy)
Intermediate Level Training Certificate
Intermediate Level Progress Report

Insert dates of satisfactory assessments ( dd/mm/yy ) :

ESSENTIAL
UNITS / A-CEX
or
ALMAT / DOPS / CBD / MISC. / COMPLETION OF UNIT OF TRAINING FORM
ICM
Paediatrics
Neuro
Cardio-thoracic
General Duties (complete minimum of eight, * mandatory)
Airway Management*
Resp/Cardiac Arrest *
Day Surgery
Head & Neck, Max-facial, Dental
Gen/Uro/Gyn
Non-theatre
Obstetrics
Orthopaedics
Regional
Sedation
Transfer Medicine
Trauma & Stabilisation
Vascular
OPTIONAL
UNITS / A-CEX
or
ALMAT / DOPS / CBD / MISC. / COMPLETION OF UNIT OF TRAINING FORM
Ophthalmic
Pain Medicine
Plastics/Burns
Paediatric ICM
Anaesthesia in Developing Countries
Conscious Sedation in Dentistry
Military Anaesthesia
Remote & Rural Anaesthesia

COMPLETION OF ADVANCED LEVEL ASSESSMENTS & UNITS OF TRAINING

Insert dates of satisfactory assessments ( dd/mm/yy ) :

SUB-SPECIALTY
UNITS / A-CEX
or
ALMAT / DOPS / CBD / MISC. / COMPLETION OF UNIT OF TRAINING FORM
ICM
Paediatrics
Paediatric ICM
Neuro
Cardio-thoracic
Obstetrics
Pain Medicine
Plastics/Burns

General duties: Flexible arrangements for advanced year:

- 12 month general block if no advanced sub-specialty year: minimum of 2 units, however several units expected.

- 6 months indicative general block, if combined with any of the above sub-specialty units.

- No general units required if advanced sub-specialty year.

GENERAL
UNITS / A-CEX
or
ALMAT / DOPS / CBD / MISC. / COMPLETION OF UNIT OF TRAINING FORM
Airway Management
Head & Neck, Max-facial, Dental
Gen/Uro/Gyn
Hepatobiliary
Vascular
Day Surgery
Sedation
Orthopaedics
Regional
Transfer Medicine
Trauma & Stabilisation

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