Section 3: Core Common Competencies A list of these is included below for completion ( referred to F ICM assessment document 2014 version 2) Approximately 20% of these need to be completed per year in order that by the end of training all have been achieved. The evidence for these needs to be confirmed by the Educational Supervisor. Trainees should print the relevant competency pages and map these and get them reviewed and signed by the Educational Supervisor. This then needs to be attached to the WPBA summary (Attachment 2) Section 4: Expanded Case summaries Minimum 4 in stage1 to at least level 2 standard Minimum 4 in stage 2 Minimum 2 in stage 3 Marked by the Educational Supervisor. Guidance for this is included below along with the marking system Can also refer to FICM documents for guidance: Section 5: MSF One per year 2 in stage 1 2 in stage 2 1 in stage 3 The educational supervisors summary of the multi-source feedback should be presented here to include the anonymised comments Multi-source Feedback – blank form attached below Section 6: Record of appraisals Record of induction meeting Record of mid-point review End of attachment review Training agreement These need to be summarised in the Educational Supervisors report Section 7: Logbook of cases – to comply with data governance requirements Unit Admission data allows yearly learning outcomes to be fulfilled Individual cases provide suitable case mix to achieve yearly learning outcome. These need to be summarised in the logbook attachment Section 8: Log book procedure/DOPS to reflect agreed CoBatrice competency assessments Minimum 30 in stage1 Minimum 15 in stage 2 Minimum 15 in stage 3 These need to be summarised in the logbook Attachment 1 DOPS need to be summarised in WPBA Attachment 2 as well. Section 9: Logbook of Airway skills – as evidenced by DOPS/mini-CEX Minimum 30 in stage 1 Minimum 30 in stage 2 Minimum 15 in stage 3 These need to be summarised in the logbook Attachment 1 DOPS need to be summarised in WPBA Attachment 2 as well. Section 10: Quality Assurance Feedback GMC Survey Completion Certificate b) JEST Completion Certificate Section 11: ES Structured Training Report Satisfactory report Previously you may have used the powerpoint report (previously
Record of educational activities: Satisfactory? ES Comments (all below need summarised in WPBA and educational activity attachment 2 ) Top 30 cases (see guide notes) YES NO Top 30 for Dual /single CCT not for joint Audits (min 1 per stage of training) YES NO Summarised in WPB a and educational attachment M&M meetings (see guide notes) YES NO Evidence of attendance at meetings-see guide Journal club presentations (1/year) YES NO Evidence of at least 1 presentation per year Teaching attendance YES NO Evidence of attendance at regional teaching Teaching delivered YES NO Delivered or organised teaching sessions? Feedback Management meetings YES NO Attend 2 in Advance or stage 3 module External meetings as approved in PDP & reflection on each YES NO Summarised in teaching WPBA (Attachment 2) Research and publications YES N/A Include a summary of experience, skills and publications in WPBA Attachment 2 Health Record Any significant health issues? YES NO If so, please give details: How many days off sick in this placement? No of days Has any essential training been missed? YES NO If so, please give details: Other reasons for extended training: e.g. Maternity leave Details of concerns/investigations: Are you aware if this trainee has been involved in any conduct, capability or Serious Untoward Incidents/Significant Event Investigation or named in any complaint? YES NO If so, are you aware if it has/ these have been resolved satisfactorily with no unresolved concerns about a trainee’s fitness to practice or conduct? YES NO Is the trainee in need of professional support? YES NO Details of concerns/investigations: Comments, if any:
Sengstaken tube placement Abdominal ultrasound/FAST CNS Lumbar puncture Brainstem death testing Intra cranial pressure monitoring Please attach this summary of your logbook, relating to the year under review. Trainee’s signature:……………………………………………… Date:……………………… FICM Tutor / Educational Supervisor signature:…………………………Date:………………………
14. 15. Local meetings Departmental ,Governance, Quality Improvement, Grand Rounds, Tutorials Date Trust Reflection present Assessor 1. 2. 3. 4. 5. 6. Audits (At least 1 per year of training) Date Completed & presented Satisfactory (Y/N) Assessor 1. 2. 3. M&M meetings Title of cases discussed/presented (At least 4 per year and reflect on at least 2 of those meetings) Date Presented or attended Reflection present Assessor 1. Presented 2. Attended 3. 4. 5. 6. Journal Clubs Title of papers presented/discussed (Presentation at least once per year) Date Presented or attended Reflection present Assessor 1. Presented 2. Attended 3. 4 5 Teaching attended Teaching regional and local attendance: Topic/title Date Trust Reflection present Assessor 1 2 3.