Record of Work Place Based Assessments Since Last Arcp Doc

Mersey Deanery ARCP Process for Anaesthesia

RECORD OF WORK PLACE BASED ASSESSMENTS for Higher Level Training DOC. 2

Personal details:
Surname:…………………………… Forename:………………………………
GMC number:…………………Year of Training:…………………… Grade:…………………………………
Specialty:…………………………………… Training Number:…………………………………………
C.C.T date:………………………………….
Unit of training / Completion date / Trust(s) where training achieved / Competent / signed
Higher Competencies
Cardiac/thoracic anaesthesia
Intensive care medicine
Neuro-anaesthesia
Obstetric anaesthesia
Paediatric anaesthesia
Pain management (chronic andacute)
General surgery/ gynae/
urology (± transplantation)
Day surgery
ENT
Orthopaedic surgery
Trauma and accidents
Vascular anaesthesia
Maxillo-facial/dental
Ophthalmic anaesthesia
Plastics/burns
Military Anaesthesia

Comments:………………………………………………………………………………

………………………………………………………………………………………

Summary of Core Assessments for Higher Training:

Unit of Training / Cardiac/Thoracic Anaesthesia
Nature of case procedure / Date / Complexity/difficulty / Assessor
DOPS
Mini-CEX
CBD
Unit of Training / Intensive Care Medicine
Nature of case procedure / Date / Complexity/difficulty / Assessor
DOPS
Mini-CEX
CBD
Unit of Training / Neuroanaesthesia
Nature of case procedure / Date / Complexity/difficulty / Assessor
DOPS
Mini-CEX
CBD
Unit of Training / Paediatric Anaesthesia
Nature of case procedure / Date / Complexity/difficulty / Assessor
DOPS
Mini-CEX
CBD
Unit of Training / General surgery/ gynae/
urology (± transplantation)
Nature of case procedure / Date / Complexity/difficulty / Assessor
DOPS
Mini-CEX
CBD

Summary of Additional Assessments for Higher Training

Unit of Training
Nature of case procedure / Date / Complexity/difficulty / Assessor
DOPS
Mini-CEX
CBD
Unit of Training
Nature of case procedure / Date / Complexity/difficulty / Assessor
DOPS
Mini-CEX
CBD
Unit of Training
Nature of case procedure / Date / Complexity/difficulty / Assessor
DOPS
Mini-CEX
CBD
Unit of Training
Nature of case procedure / Date / Complexity/difficulty / Assessor
DOPS
Mini-CEX
CBD
M.S.F (attach copy of MSF summary sheet) Date from to

Comments:………………………………………………………………………………

……………………………………………………………………………………..………………………………………………………………………………………….

………………………………………………………………………………………

Trainee’s signature…………………………………………. Date:………………

College Tutor / Educational Supervisor’s signature:……………………………..Date:………………

Summary of Additional Competencies for Advanced Training

Unit of training / Completion date / Trust(s) where training achieved / Competent / signed
Advanced Competencies
Cardiac/thoracic anaesthesia
Intensive care medicine
Neuro-anaesthesia
Obstetric anaesthesia
Paediatric anaesthesia
Pain management (chronic and acute)

Report and summary of expertise gained during advanced training in a specialist area (normally during Fellowship posts / other OOPT posts). This should take into account the relevant requirements set out in the RCA document (CCTiv).

………………………………………………………………………………………

Trainee’s signature…………………………………………. Date:………………

College Tutor / Educational Supervisor’s signature:……………………………..Date:………………

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