/ Filename: YHD-HPN-PRV / Authors: Dr D Scott
Revision No: 4 / Date of Issue: 27.11.13
Title: Porfolio Review Form / Page 3 of 3
Yorkshire & Humber Deanery Histopathology Rotation: North

Portfolio Review Form

This form should be submitted as part of preparation for ARCP or RITA, signed off by the Educational Supervisor. It confirms evidence of necessarily training activity, not necessarily covered fully by the Educational Supervisor’s Structured Report. A copy should be kept in the portfolio, and uploaded onto the RCPath LEPT system.

Trainee
Educational Supervisor
Year / Stage
NTN / CCT Date

Training Summary – Months completed on Programme and Optional Modules

Stage / Months (WTE) / Modules / yes/no/undecided
Stage A
Stage B / Higher Autopsy
Stage C / Cervical Cytology
Stage D / Research Methodology
Total

Portfolio Entries

Domain / Entry exists with documentation (yes/no) / Comments (Please confirm necessary experience against stage and curriculum)
Appraisals (minimum 3 achieved?) / Number of appraisals & dates:
Trainee attachment and experience grid
Examples of reports (Histology, cytology, autopsy):
Current level of independent reporting practice (specialty and RCPath level)
Yorkshire General EQA completion (Stages C & D)
Study leave / Total days in last year?
FRCPath Teaching
Number attended & %
Sickness / How many days in last year?
Other special leave (specify) / How many days in last year?

Examinations to be attempted in coming year

Exam / Date

Workload Summary

Minimum Requirements (annual outputs)
Stage A / Stage B / Stage C / Stage D
Surgicals / 500 / 750 / 1000 / 1500
Diagnostic cytology / 150 (archived or new) / 200(archived or new) / 300 (at least 70% new) / 300 (at least 80% new)
Autopsies / 20 / 20 (inc.2 paed) / 60 (optional) / optional
Cervical cytology / 150 (archived or new) / 200 (archived or new) / 500 (optional) / optional
Audits / 1 / 1 / 1 / 1
Log-book (cases since last ARCP)
Dates / Cases completed
(since last ARCP) / Comment
Histology / Number:
Diagnostic cytology / Number & % new cases:
Cervical Cytology / Number & % new cases:
Autopsies / Number:
Audit / Number:
Log-book (cumulative case experience)
Stage A / Stage B / Stage C / Stage D
Surgicals
Diagnostic cytology
Autopsies
Cervical cytology
Audits

WBA summary

WBA Requirements (RCPath Histopathology Curriculum, 2010)
MSF / DOP / CBD / ECE
Histopathology / 3 during training
(ST1, ST3. ST5)) / 6 Stage A
All directed / 6 Stage A
All directed / 6 Stage A
All directed
6 Stage B
4 directed / 6 Stage B
4 directed / 6 Stage B
4 directed
6 Stage C
4 directed / 6 Stage C
4 directed / 6 Stage C
4 directed
6 Stage D
all directed / 6 Stage D
all directed
Cervical Cytology / 0 / 0 / 2 / 2
Higher Autopsy / 0 / 2 / 2 / 2
Research Methodology / 0 / 2 / 2 / 2
Cumulative WBAs
MSF / DOP / CBD / ECE
Stage A
Stage B
Stage C
Stage D
Cervical Cytology
Higher Autopsies
Research Methodology

Trainee Signature: ………………………………………………….

Supervisor’s Signature: ……………………………………… Date: ……………………………

THIS IS AN OFFICIAL FORM APPROVED BY THE HISTOPATHOLOGY STC