Certification inMaternal Fetal Medicine

Training Assessment RecordCMFM – TAR

Full Name ID

Mobile

Email

Training Supervisor

Training Unit/s

Year Training Commenced

Year of Training 1 □ 2 □ 3 □ Semester 1 □ 2 □

Six -month Period _ to _

Full time □ Part time □ FTE Hours per week

Trainee Checklist

□ Six-monthly Summative Assessment Report - signed by the Training Supervisor and Trainee□ Training Supervisor has sighted the Trainee Online Logbook□ Two Clinical Training Summaries (one for the period covered by this TAR and one cumulative from commencement of

training) – download from MyRANZCOG and attach to the back of the TAR□ Assessment of Procedural Skills (APS) Summary - signed by the Training Supervisor□ Components of the CMFM Training Program Record - download from MyRANZCOG and attach to the back of the TAR□ Trainee Participation in other Professional Activities - download from MyRANZCOG and attach to the back of the TAR□ Weekly Timetable - signed by the Training Supervisor and Trainee□ Research Project Proposal and Timeline Application - (first six months ONLY) download from the website □ Research Progress Report - signed by the Training Supervisor and Trainee□ Attached Trainee Questionnaire to be completed

__________________________________________________The Overall Performance of the Trainee in this six-month training period has been

□ SATISFACTORY

□ NOT SATISFACTORY following review of CMFM Subspecialty Committee

Chair, CMFM Subspecialty Committee ………………………………………………………… Date ………………………………………

Comments

CMFM TAR (Training Assessment Record) Page 1 of 18 CMFM 2 - 03

Six-monthly Summative Assessment Report

Training Time to be Credited FTE 0.5 - 1.0 (as per training unit contract)

Training / Leave ATraining time available this period B 26

Leave - Sick(days)

-

Leave - Annual / Recreational(days)

-

Leave - Maternity / Parental (days)

-

Total Leave Days(days)

C -

Maximum 26 weeks in any one six month block, and 46 weeks in any one training year

Professional Development Leave (PDL)Detail of activity Dates Days

Approved PDL in accordance with relevant RANZCOG regulations is regarded as credited training time, provided evidence of PDL(e.g. certificate of attendance) is attached.

Office Use Only

Leave - Total in weeks (divide ‘C’ by five (5 days = 1 week)) D

Total weeks worked (‘B’ minus ‘D’) E

Total training time to be creditedBefore rounding (‘E’ times ‘A’) F

After rounding (‘F’ rounded up/down to the nearest whole week)

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Summative Assessment of Trainee’s Progress and Performance

As collated from Consultant Assessment of Trainee ReportsPlease add the relevant number of ratings given by the consultants and your own rating to the appropriate column for each item. NB: In deciding ratings, Consultants and the Training Supervisor may also take into consideration feedback from relevant health professionals (e.g. other medical, nursing and allied health staff).

Number of consultants who have contributed to this assessment

Number who have less than 10 contact hours per four-week period, with the Trainee.

Number who have greater than 10 contact hours per four-week period, with the Trainee.

Domain – Clinical Expertise please indicate in number of consultants and not ticksCompetencies Below

expectation of year level

At expectation of year level

Aboveexpectation of year level

Unable to assess

Demonstrates responsibility, reliability and initiative in undertaking clinical and other duties and follow up

Manages clinical load effectively in consultation with other members of the multidisciplinary team

Demonstrates appropriate maternal fetal medicine procedural and surgical skills

Demonstrates appropriate maternal fetal medicine non- procedural skills

Demonstrates appropriate ultrasound skills

Demonstrates appropriate documentationand organisational skills

Demonstrates continued improvement in medical expertise, clinical reasoning and judgment

Domain - Academic AbilitiesCompetencies Below

expectation of year level

At expectation of year level

Aboveexpectation of year level

Unable to assess

Demonstrates appropriate theoretical knowledge of the MFM subspecialty and principles of evidence-based medicine

Demonstrates an appropriate knowledge of the literature in obstetrics and gynaecology, and maternal and fetal medicine

Demonstrates appropriate skills in all aspects of clinical research

Demonstrates effective teaching at both undergraduate and postgraduate level

Demonstrates attendance and participation at continuing education meetings

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Domain - Professional Qualities

Training Supervisor’s summary comments

Areas of strengthAreas of strength highlighted by the consultants, other assessors and your own observations within the relevant domains.Please give examples of specific competencies.

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____________________________________________________________________________________________________Suggestions for developmentHighlighted by the consultants, other assessors and your own observations within the relevant domains.Please give specific examples of competencies where improvement is needed.

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CMFM TAR (Training Assessment Record) Page 4 of 18 CMFM 2 - 03

Competencies Below expectation of year level

At expectation of year level

Aboveexpectation of year level

Unable to assess

Communicates effectively with patients and their families

Communicates effectively with colleagues

Works as a member of a team

Demonstrates appropriate understanding and judgement of ethical issues

Accepts constructive feedback

Reviews and updates professional practice

Leadership and management responsibilities

Professionalism

Health Advocacy

Six-month Performance Summary – please tick boxes where appropriate

Clinical Training Summary

□ Completed

Trainee must meet required assessments for relevant time in training/year level (If required assessments are NOT met, the current period cannot be credited and this form must be referred for review to the CMFM Committee)

□ Trainee has met required assessment for year level

or

□ Trainee has not met required assessment for year level and is referred for review

Formative Appraisal Report (FAR) □ Completed and signed this training period

Online Logbook□ I have sighted the Trainee’s online logbook

Summative Performance (in this six-month training period)

□ Satisfactoryor□ Referred for Review to CMFM Committee If referred to CMFM Committee, a Learning Development Plan

(LDP) MUST be submitted with this Summative Assessment Report. The LDP template can be found on the RANZCOG website: www.ranzcog.edu

Signatures

Training Supervisor

□ I have discussed this Summative Assessment Report with the trainee

Training Supervisor ………………………………………….. Date …………………………

Trainee

□ My Training Supervisor has discussed this Summative Assessment with me□ I have completed a Confidential Feedback Questionnaire

Trainee ……………………………………………………………….. Date …………………………

Submit training documentationby deadlines as specified in the RANZCOG regulations for Subspecialty training

to CMFM Training Coordinator at lgrayson@ranzcog.edu.au

CMFM TAR (Training Assessment Record) Page 5 of 18 CMFM 2 - 03

Clinical Training Summary

High Risk Obstetrics

Clinical Field

Number of patients

seen in first consultation

Cumulativetotal

(for all training periods)

Number of patients with

continuing management responsibility

Cumulative total

(for all training periods)

Maternal disorders in pregnancy

Ante natal venous thrombosis/VTE or history of VTE

Severe pre-eclampsia presenting at less than 30 weeks

Other maternal medical disorders

Fetal Complications in Pregnancy

Assessment of fetal abnormality

Early onset IUGR (less than 32 weeks)

Multiple pregnancy

Other fetal complications

Involvement required during the 3 year clinical training program

Ultrasound and Prenatal Diagnosis Procedure Performedthis six months

Supervised Independently Cumulative total to date Procedure numbers required supervised and independently

Ultrasound 2000Amniocenteses 100Chorionic villus sampling 50

Procedure numbers required during the 3 year clinical training program

Other training in Ultrasound and Prenatal Diagnosis Procedure Performed Assisted Cumulative Supervised Cumulative Independently Cumulative

FBS/Transfusion

Laser Photocoagulation

Other Fetal Procedures

Training Supervisor’s signature ………………………………………………… Date ……………………………………..

Trainee Signature …………………………………………………………………… Date ……………………………………..

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Components of the CMFM Training Program

Perinatal Pathology AttendedNumber Date Meeting Location

123456789101112

Full Perinatal Autopsy1

Trainees are required to attend at least 12 clinical pathology meetings and 1 full perinatal autopsy.

Number attended in this 6-month training period …………………………. Cumulative total to date …………………………..

Genetics Clinics AttendedDate Name of Certified Geneticist Supervisor123456789101112

Trainees are required to attend 12 perinatal genetics clinics during the 3 year training program

Number attended in this 6-month training period ………………………… Cumulative total to date: ______________

Neonatology Experience

Number of hours Cumulative Total to Date

Expected Minimum over 3 year training program

Ward Rounds and management 100Education and teaching rounds 50

Trainees are required to spend 100 hours attendance at Neonatology ward rounds over the 3 year clinical training program

Paediatric SurgeryIt is desirable trainees directly observe surgical correction of the following neonatal problems during the 3 year clinical training program

Cases this six months Number of cases observed Cumulative Total to DateRepair of Abdominal wall defectRepair of Diaphragmatic herniaRepair of Bowel AtresiaRepair of Neural Tube

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Assessment of Procedural Skills (APS) Summary Sheet

Name of Trainee ……………………………………………..

Procedure being Assessed

Formative AssessmentDate and Signature of Assessor

If more than 3 formative assessments use a new sheet

Date of Summative Assessment

Summative Assessor

Surname & Signature

Summative Assessments

Attached1 2 3

Amniocentesis __ __ __

___________

__ __ __

___________

__ __ __

___________□

Chorionic Villus Sampling (CVS) __ __ __

___________

__ __ __

___________

__ __ __

___________□

Training Supervisor’s signature ………………………………………………………… Date …………………………………………………

Trainee signature ………………………………………………………………………………. Date …………………………………………………

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Weekly Timetable

Trainee Name ………………………………………………………. Year of Training 1 / 2 / 3

For the six-month period ……………………………………………………… to …………………………………………………………..

Training Unit ………………………………………………………

The Weekly Timetable is for recording your weekly timetable of activities. Please include the activity, unit/site and supervisor for each individual session undertaken. Note: If there was a significant change in the Training Program during the training period, please notify Subspecialties and submit a revised weekly timetable for the period.

For each activity you MUST indicate whether the site is Public or Private

Day of Week Morning Afternoon

MONDAY

A A

U/S U/S

S S

TUESDAY

A A

U/S U/S

S S

WEDNESDAY

A A

U/S U/S

S S

THURSDAY

A A

U/S U/S

S S

FRIDAY

A A

U/S U/S

S S

A = Activity U/S = Unit/Site S = Supervisor

During these six months, there has been no change to the prospectively approved training program at this site,including supervisors or sessions.

Training Supervisor’s signature ………………………………………………….. Date ……………………………………..

Trainee Signature …………………………………………………………………… Date ……………………………………..

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Research Progress Report

To be completed by Trainee only when Research Project Proposal and Timeline has been approved

Trainee Name ………………………………………………………. Year of Training 1 / 2 / 3

For the six-month period ……………………………………………………… to …………………………………………………………..

Training Supervisor ………………………………………………………

Title of Research Project …………………………………………………………………………………………………………………………….

Select the option below that applies to the research in which you are involved

□ I am completing a Research Project as part of my assessment

OR

□ I have completed a formal higher research degree qualification in an area relevant to my subspecialty that has been approved by the CMFM Subspecialty Committee, and I am involved in ongoing research.

Trainee Research Progress Report

Describe the progress made during this training period against the goals set and the timeline. OR

Describe the progress made in the ongoing research in which you are involved.

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Institutional Ethics Committee approval obtained YES □ NO □

Trainee Signature …………………………………………………………………… Date ……………………………………..

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Research Progress ReportTo be completed by Training Supervisor

If the trainee is completing a Research Project as part of their assessment, please describe the progress made during this period against their set goals and timeline.

Role of the Trainee Yes NoHas the trainee been actively involved in their research? □ □Has the research project changed from the original proposal? □ □ If Yes, how has the project changed and is this suitable to be considered for the subspecialty training? □ □

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Aims Yes NoHas the trainee made satisfactory progress in this area during the past six months? □ □If No, please comment.

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Literature Review Yes NoHas a literature review or a critical appraisal of the literature been undertaken? □ □If No, please comment._______________________________________________________________________________________

_______________________________________________________________________________________

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Methods Has the trainee provided adequate information on the progress of - Yes NoData collection □ □Data analysis □ □If no, please comment_______________________________________________________________________________________

_______________________________________________________________________________________

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Research Content Yes No Has the trainee shown clear progress and learning in research techniques? □ □Has the research progress as proposed in the timeline been followed in this six months? □ □Results Yes No N/AHas the trainee been able to clearly describe any results established in the past six months? □ □ □If No, please comment._______________________________________________________________________________________

______________________________________________________________________________________________Conclusions Yes No N/AHas the trainee been able to clearly outline any conclusions established in the past six months? □ □ □If No, please comment.

_______________________________________________________________________________________

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CMFM TAR (Training Assessment Record) Page 11 of 18 CMFM 2 - 03

Overall Opinion of the Research Project Progress

Progress in the trainee’s Research Project at this stage of training is -

Satisfactory □ Unsatisfactory □Comments_________________________________________________________________________________________________

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If the trainee has completed an approved formal higher research qualification, please describe the progress made in the ongoing research in which the trainee is involved

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Training Supervisor’s signature ………………………………………………….. Date ……………………………………..

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Trainee and Training Supervisor Instructions

The Six-monthly Summative Assessment is an important record of the Trainee’s progress and assessment experiences.

The Trainee and the Training Supervisor MUST meet within the last 2-4 weeks of the six month training period so that the assessment is done BEFORE the Trainee commences the next training period.

It is the responsibility of the Trainee to ensure that the Training Supervisor is available to meet with him/her to discuss the Summative Assessment prior to submission to Subspecialties, College House.

The Training Supervisor, or their nominee, is responsible for distributing and collecting the Consultant Assessment forms which are the basis for the Summative Assessment Six-monthly Report, NOT the Trainee.

The Trainee should complete the training time calculation section in consultation with the Training Supervisor. The Training Supervisor is responsible for the initial checking that assessment requirements for the relevant stage in training/year

level have been met by the time of this Summative Assessment. Both the Trainee and Training Supervisor must sign the Summative Assessment. Please ensure that all details are completed on each page of the Summative Assessment. It is the Trainee’s responsibility to submit the completed Summative Assessment Report to Subspecialties, College House, for

review and signing by the CMFM Committee Chair. This must be done not more than six weeks from the end of the six-month training period.

If the Training Supervisor ticks the box “Referred for Review to the CMFM Committee” on this Summative Assessment Six-monthly Report, a Learning Development Plan (LDP) MUST be submitted with this report. The LDP template can be found at: https://ranzcog.edu.au/Training/Subspecialist-Training/Current-Trainees-(4)/Training-Documents

If a Trainee receives three (3) “Not Satisfactory” assessments in the course of their training, this may result in removal from the Training Program.

Submission of training documents by due date

If the Summative Assessment Six-monthly Report is not submitted within six weeks of the end of the relevant training period, the entire six-month training period will NOT be credited and will result in a “Not Satisfactory” assessment. If this occurs a second time, the Trainee will face removal from the program.

Trainees, who believe they have valid grounds for NOT submitting their training or assessment documents by the due date, should apply via the Exceptional Circumstances for Special Consideration Application Form and submit documentary evidence along with the administrative fee. This form can be accessed on the College website: https://ranzcog.edu.au/Our-College/Governance/Policies-Procedures/Special-Consideration-and-Reconsideration

The Exceptional Circumstances for Special Consideration Application Form must be received within 72 hours of the due date for submission of the relevant Six-monthly Summative Assessment Report.

The specified clinical and assessment requirements must be met for the relevant stage in training/year level or the six months of that training period will not be credited.

Notes to Training Supervisors

Distribute Consultant Assessment Reports to between 2 and 6 consultants who work closely with the Trainee and are best able to assess the Trainee’s performance.

After collating the Consultant Assessment reports, the Training Supervisor must recommend whether the assessment report is assessed as “Satisfactory” or “Referred for Review to the CMFM Committee”, noting that the report must be referred if two (2) or more consultants rate a trainee as “BELOW expectation for year level of training” for two or more competencies, regardless of the domain(s) in which the competencies are located.

If the box “Referred for Review to CMFM Committee” is ticked by the Training Supervisor, a Learning Development Plan (LDP) MUST be developed with the Trainee and submitted with the Training Assessment Record.

The LDP template can be found at: https://ranzcog.edu.au/Training/Subspecialist-Training/Current-Trainees-(4)/Training-Documents

CMFM TAR (Training Assessment Record) Page 13 of 18 CMFM 2 - 03

Function of the Training Assessment Record (TAR)

The Training Assessment Record (TAR) has been designed to enable trainees to record a summary of all necessary training and assessment experiences required for the CMFM Training Program specifically for assessment purposes.

The TAR is a facility for trainees to record consecutively the many aspects that comprise the training program being undertaken so that Training Supervisors and the CMFM Subspecialty Committee will be able to assess a trainee’s progress relevant to the requirements of the Clinical Training Program and the training experiences recorded at the end of each six-month training period.

The TAR must be forwarded to the Training Supervisor and CMFM Subspecialty Committee at the end of each six-month training period for assessment. Training Assessment Records must be kept by the trainee for the duration of the Clinical Training Program being completed. The TAR is available on the College website, and additional pages may be selectively printed as is necessary.

You must maintain an updated copy of your TAR at all times – it is an essential record of your training and assessment experiencesfor the three years of training. Training Supervisors or the Chair of the CMFM Subspecialty Committee may askto see your TAR at any time. An updated copy should always be available.

The Master Sheet is a record of all completed assessment requirements during CMFM subspecialty training. A copy of the Master Sheet must be submitted at the end of each six-month training period with the TAR

For further information regarding any of the necessary training documentation, trainees are advised to consult the CMFM Training Handbook which can be found at: https://ranzcog.edu.au/Training/Subspecialist-Training/Current-Trainees-(4)/Training-Program-Handbooks and the RANZCOG Regulations, Section D, Subspecialties which can be found at: https://ranzcog.edu.au/Our-College/Governance/Constitution-Regulations

Contact

If your contact details change, please notify the College as soon as possible.

For all training documentation enquiries, please contact Subspecialties Services at College HouseLisa GraysonCoordinator – CMFM Subspecialty Training ProgramTel +61 3 9412 2990Email lgrayson@ranzcog.edu.au

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Index

Page

Six-monthly Summative Assessment Report .................................................................................. 2-5

Training Assessment Records ......................................................................................................... 6-9

Weekly Timetables ......................................................................................................................... 10

Research Project ............................................................................................................................. 11-13

Information ..................................................................................................................................... 14-16

CMFM TAR (Training Assessment Record) Page 15 of 18 CMFM 2 - 03

The purpose of this questionnaire is to obtain vital feedback from subspecialty trainees about their training experiences over the past six months in their respective training units/sites, for the purpose of continuous improvement to the Subspecialty Training Program.

Subspecialties Services is responsible for the conduct, processing and analysis of the surveys. As part of this process, trainees are asked to provide their name and/or other identifying details. This is so that the Chair of your respective Subspecialty can contact you, if the College becomes aware of any issue that poses a concern to your training experience. In this regard, the College has a responsibility to ensure that appropriate follow-through is undertaken. Otherwise, the reporting of aggregated results in future reports prepared by Subspecialties Services will ensure that individuals are de-identified.

It is important that If your training unit comprises and you train in more than one site, you are requested to provide a separate questionnaire

for each site as it is important for the Chair of the relevant Committee to understand your experience in each site. Training Supervisor refers to your overall Training Supervisor; Consultants may be those who supervise your work or you

work closely with for particular sessions.1. Trainee Name

2. Location of training

3. Name of Training Unit / Site Unit …………………………………………………………………………..

Site 1 …………………………………………………………………………..

Site 2 …………………………………………………………………………..

4. Period of training: from to

5. Year of training: 1 2 3 Semester: 1 2

Complete this section only if this is your first semester of training at this unit; otherwise indicate N/A for all questions and proceed to Section 76. Considering your initial experience at this unit, please rate your level of agreement with the following statements:

Strongly Disagree

Disagree Agree Strongly Agree

N/A

An orientation session was provided for me at this unitThe training unit has a documented in-hospital credentialing processMy training was well organised and I had clearly defined responsibilitiesI had an appropriate timetableI was made aware of the unit’s policy on bullying and harassmentI was made aware of the unit’s policy on dispute resolutionComments:

7. During the past semester at this unit/site Never Rarely Some

timesConsistently

N/A

I had the opportunity to develop surgical/procedural skillsI had the opportunity to develop clinical skillsI was given time to practise and develop new skillsI was exposed to a broad range of relevant subspecialty experiencesI was given opportunities for independent decision makingI had an adequate workload that provided appropriate clinical experienceI was given opportunity and encouragement to undertake researchI was given adequate research support and feedbackComments:

CMFM TAR (Training Assessment Record) Page 16 of 18 CMFM 2 - 03

8. My training supervisor at this unit/site Never Rarely Someti

mesConsistently

N/A

Discussed my training needs with meEncouraged me to bring up problems or concernsListened attentively and was respectful towards meWas easily approachable for consultationStated learning goals clearly and prioritised these goalsGave regular informal feedback on performance and progress in between three monthly appraisal and six monthly assessmentGave constructive feedback on performance and progress at the formal three and six month assessment periodsComments:

9. In general, Consultants I worked with:Never Rarely Someti

mesConsistently

N/A

Were supportive of my training experienceWere positive role models as subspecialty practitionersDelegated responsibilities appropriatelyCommunicated effectivelyEvaluated trainees’ subspecialty skills and knowledge regularlyEnsured I tried to have adequate primary operator experiencegave me meaningful feedback on my performance and progressOffered suggestions for improvement, as appropriateComments:

Strongly disagree

Disagree Agree Strongly agree

N/A

10. SupervisionMy unit ensures there are adequate senior medical staff to provide effective training, support and supervision of trainees, essential to ensuring safety and quality of clinical servicesExamples/Comments:

11. Clinical ExperienceMy unit offers experience in a range of clinical aspects of the training programMy timetable achieves a balance between service delivery and trainingExamples/Comments:

12. Educational Programs and ActivitiesThe unit provides suitable interactive teaching, including discussion of current literatureMy timetable allows me to attend clinical management, multidisciplinary and/or scientific meetingsExamples/Comments:

CMFM TAR (Training Assessment Record) Page 17 of 18 CMFM 2 - 03

Strongly disagree

Disagree Agree Strongly agree

N/A

13. FacilitiesThe unit offers the range of facilities relevant to the subspecialty, such as laboratory, diagnostic services, or other (please specify)Examples/Comments:

14. ResearchMy timetable allows protected time and opportunity for research

The unit offers appropriate support and feedback for research

Examples/Comments:

15. Quality AssuranceThe training program provides the opportunity to develop my awareness of legal and/or ethical issues that arise in the practice settingExamples/Comments:

16. Publications and PresentationsThe training program provides the opportunity to publish and/or present my research findingsExamples/Comments:

17. General The unit offers opportunities for insight into running a subspecialist practiceExamples/Comments:

The training program provides me with the opportunity to develop my leadership skills and managing of others in the practice settingExamples/Comments:

College systems and administrative processes ensure a well-organised training experienceExamples/Comments:

I receive appropriate information and guidance from the College with respect to the training programExamples/Comments:

18. Are there aspects of your training that you consider are not being covered in your current program?

Yes No

Examples/Comments:

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