Specialtytraining Committee in Cardiology (Australia)

/ Specialty Training Committee (STC) in Cardiology
Final Supervisor’s Report
Important Information

• For each period of training, all nominated supervisors are required to either complete and co-sign a composite report OR complete an individual report
• Training will not be certified without a Final Supervisor’s Report covering the entire period of supervision
• Supervisors should ensure that the trainee receives a copy of all Final Supervisor’s Reports submitted for assessment, to ensure the trainee can provide copies of these to subsequent supervisors
• The College may discuss the contents of Final Supervisor’s Reports with subsequent supervisors, where this is deemed necessary for support or assessment purposes.

You are advised to retain a copy of the completed form for your records.
Before you complete this form:
Please ensure you have read and familiarised yourself with the following:
- The relevant Advanced Training Program Requirements Handbook
- Flexible Training Policy
- Progression through Training Policy
Submission Dates
31 January 2015
(Australia) / Final Supervisor’s Reports for 2015 must be received at the College.
15 July 2015 (Australia)
31 May 2015
(New Zealand) / Final Supervisors’ Reports for the first half of the year for trainees doing less than, or equal to, six-month rotations must be received at the College
15 October 2015
(Australia) / Final Supervisor’s Reports for final year trainees must be received at the College to allow admission to Fellowship in December 2015.
31 January 2016
(Australia)
31 October 2015 (New Zealand) / Final Supervisors’ Reports for trainees who are not in their final year of training
must be received at the College
Privacy Legislation
The College complies with the requirements of the national Privacy Act 1988 (Cwlth) (Australia) and the Privacy Act 1993 (New Zealand) and has adopted the Australian National Privacy Principles as the guidelines for ensuring the protection of personal information in its care. This policy applies to all personal information collected, stored, used and disclosed by the College.
Personal and training related information that you provide will only be used by the College (including its boards and training committees, state/regional committees and supervisors of training) to administer, assess and develop the training program and monitor workforce trends. Confirmation of training status will be provided to Medical Boards upon request. Further details can be found here.
Enquiries & Application Submission

Enquiries:

Phone: +61 2 8247 6231
Email: / Please send applications to:
Cardiology
The Royal Australasian College of Physicians
145 Macquarie Street
SYDNEY NSW 2000 AUSTRALIA
Faxed or emailed reports will not be accepted by the Australian office
Pre-Submission Checklist
 if completed
I have read the important information on the front of this form.
My supervisors and I have signed this form on pages 8 and 9 VERY IMPORTANT!
My supervisor has given me a copy of the completed Supervisor's Report for my personal records. (Trainees are required to show previous reports to subsequent supervisors.)
I have posted the original of the completed report to the College by the appropriate due date (see front of form). Faxed or emailed forms are not accepted by the Australian office.
The supervisor completing this Final Supervisor’s Report is the supervisor nominated on my Annual Application for Approval of Advanced Training.
The dates on this form correspond to the entire period of supervision, as nominated on my Annual Application for Approval of Advanced Training.
Notification of Certification Decision
Once your report has been considered by the nominated supervising committee(s), you will be notified of the certification decision. Whenever possible, this advice will be sent within eight weeks of the submission deadline. The committee will either certify the training or defer the decision pending provision of further information or the outcome of an Independent Review of Training. In rare circumstances, the training may not be certified.
Consideration of reports submitted after the deadline may be delayed. The College retains the right to not certify training if the report is submitted after the specified deadline. If your report is submitted late, you must attach an Application for Special Consideration.
Trainees should refer to the Progression Through Training Policy for further details.

Adult Medicine Division

SpecialtyTraining Committee in Cardiology (Australia)

2015Final Supervisor’s Report

Important information:

• For each period of training, supervisors are required to either:
• complete and co-sign a composite report OR
• complete an individual report
• Training will not be certified without a Final Supervisor’s Report covering the entire period of supervision
• Supervisors should ensure that the trainee receives a copy of all Final Supervisor’s Reports submitted for assessment, to ensure the trainee can provide copies of these to subsequent supervisors
• The College may discuss the contents of Final Supervisor’s Reports with subsequent supervisors, where this is deemed necessary for support or assessment purposes

TRAINEE DETAILS AND TRAINING POSITION

Full Name of Trainee
MIN (if known)
Report covers period / From / To
Date (dd/mm/yy) / Date (dd/mm/yy)
Training position
Year of advanced training / 1st2nd3rd4th

SUPERVISOR DETAILS

Name of Supervisor
Name of Co-supervisor
Hospital
Contact information

RACP INFORMATION

Enquiries
Education Officer
Phone:61 2 8247 6231
Fax:61 2 9256 9698
Email: / Please send report to:
Education Services
The RoyalAustralasianCollege of Physicians
145 Macquarie Street
SYDNEY NSW 2000 AUSTRALIA

SUMMARY OF TRAINING YEAR

a)Are you satisfied with the overall performance of the trainee during the period covered by this report? / YesNo

If not, are there any specific factors which may have affected this trainee’s performance or do you have any reservations about performance?

b)Have the goals identified at the beginning of the training period been met?

c)For a trainee completing advanced training only

In your opinion, is the trainee now a competent physician and capable of providing a
high standard of medical care without supervision?

d) For trainees not completing advanced training this year

What are the major training needs of this trainee prior to admission to Fellowship?

ASSESSMENT OF THE CURRENT YEAR OF TRAINING

Please rate the trainee’s performance for each area according to the scale below.

Interpretation of the Rating Scale
Falls far short of expected standards
Falls short of expected standards
Consistent with level of training
Better than expected standards
Exceptional performance
N/ANot Applicable to this training period
54321N/A / Level and Application of Medical KnowledgeDemonstrates up-to-date knowledge required to manage patients. Shows ability to use the knowledge and other derived evidence based information
54321N/A / Clinical Judgement/Patient Management/ Medical CareDemonstrates ability to integrate cognitive and clinical skills, and consider alternatives in making diagnostic and therapeutic decisions. Shows wisdom in selecting treatment; adapts management to different circumstances. Effectively manages patients through integration of skills resulting in comprehensive high quality care.
54321N/A / Responsibility/Self Assessment
Accepts responsibility for own actions and understands the limitations of own knowledge and experience.
Accepts the limits of own competence and functions within own capabilities; seeks advice and assistance when appropriate; accepts criticism
54321N/A / Interpersonal/Communication Skills/ Psychological DevelopmentDemonstrates ability to relate to and communicate with patients and their families. Demonstrates ability to recognise and/or respond to psychological aspects of illness.
54321N/A / Humanistic Qualities/ Respect/ Moral and Ethical BehaviourDemonstrates integrity and compassion in patient care. Shows personal commitment to honouring the choices and rights of other persons. Exhibits high standards of moral and ethical behaviour towards patients and families.
54321N/A / Procedural Skills
Demonstrates ability to perform practical/technical procedures
54321N/A / Problem Solving SkillsCritically assesses information, identifies major issues, makes timely decisions and acts upon them
54321N/A / Professional Attitudes and Behaviour/ Relationships with Medical and other StaffShows honesty at all times in their work; puts patient welfare ahead of personal considerationMaintains the respect of his/her colleagues, including nursing, allied health and clerical staff.
54321N/A / Research Methodology/ Quality AssuranceUnderstands scientific methodology; participates in research studies by formulating and testing hypothesis and analysing the results. Demonstrates ability to initiate and evaluate Quality Assurance programs.
54321N/A / Record Keeping/ Discharge/Planning Summaries/ ReportsMaintains complete and orderly records and up-to-date progress notes. Ensures that all problems are explained prior to discharge from hospital; prepares concise and prompt discharge summaries. Completes succinct and accurate reports without delay; communicates with referring practitioner for continuing care.
54321N/A / Organisational Skills
Demonstrates ability to plan, coordinate and complete administrative tasks associated with medical care.
54321N/A / Continuing Education
Shows a resourceful attitude towards continuing education to enhance quality of care.

PREP REQUIREMENTS

Throughout this period of training, please indicate if the trainee undertook the following activities:

Yes / No / Learning Needs Analysis (2 required per training year)
Yes / No / Mini-Clinical Evaluation Exercise (2 required per training year)
Yes / No / Case-based Discussion (2 required per training year)

Please comment on specific areas that these activities could focus on in future

Please comment on the trainee’sstrengths

Please comment on the areas that require further development/training and indicate how this should be achieved

OTHER REQUIREMENTS

Has the trainee fulfilled the Electrophysiology requirements?
If yes, please append an EP Supervisor’s Report
(This applies only to trainees who commenced Cardiology training from 2009) / Yes – report attached
Yes – report submitted previously
YesNoNo
Has the trainee fulfilled the Cardiothoracic Surgical Training requirement?
If yes, please append a CTS Supervisor’s Report
(This only applies to trainees who commenced Cardiology training from 2009) / Yes – report attached
Yes – report submitted
YesNoNo
Has the trainee completed an Audit / QA?
(Two to be completed and presented within the training hospital over the three year training program.) / One Audit/QA completed
Both Audit / QAs completed
YesNoNot yet completed
Has the trainee completed the presentation / publication requirement?
If yes, please submit a copy of the abstract/ publication to the College. / Yes – abstract attached
Yes – abstractsubmitted
YesNoNo

PROCEDURAL SKILLS

This section is to be completed by trainee and supervisor.Please state the number of experiences by the trainee to the following procedures.Note total numbers for EACH year of training MUST be shown in this table.

Training Year 1 / Training Year 2 / Training Year 3 / Total Number
Supervised reporting of Holter monitors
Supervision and reporting of exercise ECG tests
Supervised reporting of echocardiograms
Performance and reporting of transthoracic echocardiograms
Performance and reporting of transoesophageal echocardiograms
Observe or participate in stress echo cases
Performance of direct current cardioversion
Performance of temporary transvenous pacemaker insertion
Participate in or observe pacemaker implantation
Supervision of permanent pacemaker function testing at pacemaker clinics
Performance and reporting of right heart catheterisation and haemodynamics
Performance and reporting of coronary angiography – Primary Operator & Assistant
Supervised insertion of intra-aortic balloon pumps
Pericardial aspiration
Involvement in decision making concerning referral for EP studies
Observation of EP procedures and interpretation of reports
Observation of catheter ablation procedures and interpretation of reports
Involvement in decision making concerning referral for ICD, observation of the procedure and post-procedure management
Participate in decision-making, assessment and management of patients undergoing cardiac resynchronisation therapy
Management of patients in an ambulatory care (outpatient) setting

The accuracy and currency of the log book is of utmost importance. The STC in Cardiology may request to review the log book at any stage of the training program.

On how many occasions have you reviewed the log book with the trainee this year? / 123456789101112131415161718192021222324
Are the summary numbers in the table above a true and accurate indication of the trainee’s experience to date? / YesNo

Please comment on the trainee’s procedural experience and skills level to date:

SUPERVISOR/TRAINEE COMMUNICATION

Dates of formal trainee meetings:

1. / 2. / 3. / 4.
Date / Date / Date / Date

Comments on meetings:

ASSESSMENT OF THE YEAR IN WHICH THE EXAMINATION IS PASSED

Has the trainee attempted the FRACP Examination or other examinations during this year? / NoYes
If YES has preparation for the examination adversely affected advanced training? / NoYes
Please specify below:
Did the trainee take any leave during the period covered by this report? / YesNo

If yes, please indicate the period(s) and types(s) of (eg, annual, maternity, paternity, sick) leave:

Period of leave /

Type of leave

from / to
from / to
from / to

SUPERVISOR’S COMMENTS

 / I have discussed the Trainee’s progress with my fellow Supervisor
 / I have discussed this assessment with the Trainee and make the following comments:
or
 / I have not discussed this assessment with the Trainee for the following reasons:
Supervisor's Signature / Date (dd/mm/yy)

CO-SUPERVISOR’S COMMENTS

Co-supervisors are only required to complete a separate report if there is a difference of opinion regarding the trainee’s performance or progress

Name of Co-Supervisor
 / I have discussed the Trainee’s progress with my fellow Supervisor.
 / I have discussed this assessment with the Trainee and make the following comments:
or
 / I have not discussed this assessment with the Trainee for the following reasons:
Co-Supervisor's Signature / Date (dd/mm/yy)

TRAINEE’S COMMENTS

 / I have discussed this assessment with my Supervisor(s) and make the following comments:
Trainee's Signature / Date (dd/mm/yy)

Thank you for completing this report. Please ensure that you send the original to the College before the deadline. It is also advised that you make a copy for your records.______

SUBMISSION DATES FOR 2015

NOTE: All trainees undertaking two or more rotations with different supervisors or at different sites in 2015 are required to submit a Final Supervisor’s Report at the end of EVERY rotation for the year to be certified.

For first and second year Cardiology trainees in 2015:

15 July 2015Mid-year Progress Reports must be received at the College on or before this date

31 January 2016Final Supervisors’ Reports must be received at the College

For final year Cardiology trainees in 2015:

15 July 2015Mid-year Progress Reports must be received at the College on or before this date

15 October 2015Final Supervisors’ Reports must be received at the College

CHECKLIST FOR TRAINEES

 if completed / My Supervisor(s) and I have signed this form on page 7-8 VERY IMPORTANT!
My Supervisor(s) has given me a copy of the completed Supervisor’s Report for my personal records. (Trainees are required to show previous reports to subsequent supervisors).
The Supervisor completing this Final Supervisor’s Report is the Supervisor nominated on my Annual Application for Approval of Advanced Training.
The dates on this form correspond to the entire period of supervision, as nominated on my Annual Application for Approval of Advanced Training.

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