1

Wessex School of Anaesthesia

Educational Supervisor’s Structured Report:

This is an important document. Trainees should download it from the School website and enter as many details as possible before discussing it with their Educational Supervisor (ES) who will complete it with them.

Achievements since the previous ARCP should be detailed.

On completion this form should be submitted to the ARCP panel via the Deanery by the trainee’s ES or College Tutor (CT). If this form is emailed, it should be sent from a secure (NHS) address and the box at the end of the document should be marked to confirm that the trainee has seen it. If sent by post then the trainee should countersign it.

If a completed form is not received by the deadline stated, the ARCP panel will issue an outcome 5 (incomplete evidence presented – additional training time may be required) and a face to face ARCP will be held at a later date. No exceptions will be allowed.

Name of person submitting report:

Position:

Training unit [hospital(s)]

Trainee’s name:

GMC number:

Deanery training number:

RCA registration number:

Previous placements in programme:

Training Unit Dates (dd/mm/yy to – from)

1.

2.

Current placement:

Dates of last ARCP (dd/mm/yy):

Exam status (with dates):

Workplace based assessments in current placement/s (only successful WBAs should be included here) since last ARCP:

Workplace Based Assessments (number)
Unit of Training / A-CEX / CBD / DOPS / ALMAT

(Add rows as necessary)

MSF (360o)

(An MSF is recommended once at basic, intermediate and advanced levels unless special circumstances)

(The “normal” process of feedback from consultants does NOT count as 360o feedback).

An MSF has been conducted during this phase of my training and there is a summary in my portfolio
(if possible, please provide a summary here) / Yes/No
(delete as appropriate) / Date:

CSAFs or competences obtained (list all modules – clinical & non-clinical):

Clinical supervisors end of unit Assessment Form[s] CSAF:

Unit of Training / Date / CSAF (yes/no)

(Add rows as necessary)

www.rcoa.ac.uk/docs/TrainingProgramme2010.pdf

Training forms obtained to date

(http://www.rcoa.ac.uk/index.asp?PageID=34):

Date obtained / Comments
IAC
IACOA
BLTC
ILTC
Notification of Completion of Training
Other

Patient surveys:

Other (please describe):

Experiential outcomes

Activity Date/s Outcomes Comments

(Please give brief descriptions of nature of activity where appropriate).

1. Log-book summary (must be annualised) expected activity achieved/

not achieved

Please provide details of (and specify, as appropriate whether work in progress, whether presented, submitted for publication, accepted for publication and if so where):

2. Audits: briefly describe each one and indicate (with dates where appropriate):

completed/not completed

presented/not presented

loop closed

3. Patient safety project:

4. Research projects:

5. Publications:

6. Teaching:

7. Management development:

8. Presentations:

9. Courses attended (list in chronological order):

Other outcomes (please add comments as appropriate)

1. Critical incident(s): discussed with CS and/or ES

ongoing/issues resolved

comments:

2. Serious untoward incident (SUI): yes/no

(Specific clinical details NOT required here)

ongoing/resolved

comments:

3. Complaint(s): resolved/pending/ no case to find/accountable

4. Other:

5. Reflective Notes:

(this section should be used for the trainee to write a brief summary of his or her achievements since their last ARCP outlining the high points and also any difficulties encountered and how they were, or are being addressed)

Educational Supervisor/College Tutors summary report – based on in-house assessments and mutually agreed information from appraisal meetings:

Appraisal / n =
Scores / Range
Preoperative assessment and clinical judgement
Punctuality and organisation
Anaesthetic plan
Anaesthetic record
Technical ability and hygiene
Ability to work under stress
Vigilance and situational awareness
Postoperative plan
Consideration of patient
Team working
Overall ability

Compared to current grade:

Above expectations = 4;

Meets expectations = 3;

Borderline = 2;

Below expectations = 1

Clinical Judgement:

Technical Skills:

Commitment and Conscientiousness:

Professional Relationship with staff and patients:

Research, Audit and Presentations:

Administrative Ability:

Potential to obtain a consultant post:

Assessment of Communication Skills, Attitudes and Behaviour:

General comments about overall progress:

I confirm that this is an accurate description/summary of this trainee’s learning portfolio, covering the time period from __/__/_____ to __/__/_____

Signed by ______Date______

(ES or CT)

Signed by ______Date______(trainee)

(It is essential that the trainee should have seen and agreed with the contents of this structured ES report before its submission for the ARCP. Please seek advice from the Deanery staff or TPDs if necessary).

If sent electronically, please confirm that the trainee has seen the completed form by marking the box:

Updated on 01.02.11.