AHP Triennial Review Form

The HCPC standards of Education and Training (2012) make a number of stipulations concerning the provision of high quality practice placements to Students. These standards ensure that the quality and quantity of appropriately qualified and supported mentors and practice educators can be demonstrated and audited to ensure ongoing quality assurance between the placement provider (the Trust) and the Healthcare Education Institute. Failure to provide evidence of annual mentorship update and/or recent mentoring or other education activity will require an individual to participate in a mentorship / supervisor development plan with clear outcomes and timescales, or becoming ‘inactive’ as a mentor. Practitioners should retain a copy of this form in their portfolio and return a copy to the Clinical Education Team, Education Centre.

Department: ______Mentor’s Name:______

Date:______Line Manager: ______

Statement / Development Plan Required? * / Review Date (if development plan implemented / For use Post Development Plan if applicable
I can provide evidence that I have contributed to mentoring/ supervising2 students in the last 3 years? / yes / no / yes / no / yes / no
I can provide evidence that I have attended a face-to-face update session in the last 3 years? / yes / no / yes / no / yes / no
I can demonstrate that I meet the competencies set out in the HCPC Standards of Education and Training specifically around Practice Placements (5.1-5.13) and I comply with the HCPC Standards of Conduct, Performance and Ethics, as well as the Standards for Continuing Professional Development / yes / no / yes / no / yes / no

* In the event that the Line Manager is not satisfied that all of the criteria are being or have been met then a development plan should be instigated between the mentor and their appraiser / manager (see next page).

Following this triennial review I certify that I am competent to perform the role of mentor/practice educator for AHP programmes within my professional area of practice
Signed ______Print Name ______
Designation ______Date ______

Line Manager (print name) ______

Line Manager (signed) ______

Date______
TRIENNIAL REVIEW DEVELOPMENT PLAN (if required)
Mentors Name / Department
My Learning Needs are: / Date
Indicate how you plan to meet your learning needs / Date
Progress Report /
Date

AP Nov 2013 AHP TR form