Supervisor Report
Immunopathology
Please review the Trainee’s portfolio and logbook before completing this report
RCPA ID no.
Name of Trainee (please print)
RACP ID no
(joint trainees only)
Name of organisation
Year of training
1
2
3
4
5
If >5, please specify
Training period - provide full, accurate
dates for accreditation of training
______/_____/_____ to ___/______/_______
 Full Time or
Specify hours per week employed
 Part Time
Leave (taken or planned within this
training period
Is this a pre-examination report?
 Annual
……..weeks or …….days
 Study leave
……..weeks or …….days
 Sick leave
……..weeks or …….days
 Parental/maternity
……..weeks or …….days
 No
 Yes
Name of supervisor (please print)
Leave taken by supervisor during
this training period
23 February 2016
 Part I
 Part II
Supervisor RCPA ID no.
Arrangements made for supervision during period of
supervisor leave
Page 1 of 4
Please inspect the forms in the Trainee’s portfolio and use the Table below to record evidence of
completion
Portfolio items with minimum requirements
Number in
current
year or
rotation
Minimum for
Part I pre-exam
Supervisor’s
report
Minimum for
Part II pre-exam
Supervisor’s
report
DOPS: 6 different techniques
during training
4 techniques
2 techniques
DOCS for telephone consults
4 per year
4 per year
DOCS for oral presentations
1 per year
1 per year
CbD
2 per year
2 per year
1 only
Not applicable
Teaching sessions attended
Min 12 per yr
Min 12 per yr
Teaching sessions conducted
Min 3 per yr
Min 3 per yr
all
all
Previous
total
Cumulative
Total
Laboratory safety checklist
Previous supervisor reports
Please inspect the Trainee’s logbook and record the number of tests reported in the Table below.
Portfolio items with no minimum requirements
Type of laboratory
investigation
Autoimmune serology
- Adult
- Paediatric/Neonatal
Flow cytometry
Previous total
number
reported
Total in
current year/
rotation
Cumulative
total
Comments
Immunochemistry
Tissue typing
Lymphocyte function tests
Allergy tests
Professional qualities: e-Learning modules
Date completed
Please specify whether RCPA module or workplace training
Cultural competence
Ethics
Management
Quality
For pre-examination supervisor’s reports:
Does the print-out of the portfolio summary spreadsheet accurately record the contents of the portfolio?
Yes
No
23 February 2016
Page 2 of 4
Please score the Trainee’s performance using this scale during the current assessment period
1. Performance currently falls far short of expected standards. Trainee requires supervision and
frequent cueing on routine tasks.
2. Performance currently falls short of expected standards.. Trainee requires supervision and some
cueing on routine tasks.
3. Performance is as expected for the level of training. Trainee is able to carry out routine task unaided.
Supervisory input needed for complex tasks.
4. Performance is better than expected for the level of training.
5. Exceptional performance. Able to practise independently and provide supervision to junior trainees.
Very few trainees will fall into this category.
N/A not applicable to this training period
Autoimmune
serology
Flow
cytometry
Immunochemistry
Tissue
typing
Lymphocyte
function tests
Allergy
tests
Skill at bench level
Knowledge of method principles
Ability to make a diagnosis
Knowledge of criteria for
satisfactory tests
Quality of written reports and
interpretive comments
Ability to summarise relevant
clinical information and lab data
Knowledge of clinicopathological correlation and
clinical relevance of diagnosis
Participation in trouble shooting
Score
Professional behaviours and research
Reliability, confidence, initiative
Able to organise work, manage time, prioritise, follow up, complete tasks
Able to maintain orderly records and up-to-date progress notes
Completes succinct, accurate and timely reports; communicates with referring practitioner
Knowledge of laboratory management, safety and quality assurance
Attention to professional confidentiality, ethical standards, medico-legal obligations
Awareness of own limitations: consults when needs help, receptive to feedback & other views
Interactions with others (peers, seniors, clerical and laboratory staff, supervisor, clinicians)
Shows a resourceful attitude towards continuing education to enhance clinical practice
Presentations at meetings (eg, grand rounds, clinical meetings)
Involvement in teaching/supervision
In basic and clinical research, knowledge of scientific methodology and ability to formulate and
test hypotheses and analyse the results of research studies
Able to critically analyse published research, including statistical analysis
Ability to prepare a manuscript for publication
23 February 2016
Page 3 of 4
Overall evaluation
Areas of strength in professional practice (please summarise)
Areas for development in professional practice (please summarise)
Is specific further professional development required?
Yes
No
If yes, please outline process
Other comments (if insufficient space, please attach sheet)
Signatures
Trainee
Date
(please PRINT name and sign)
RCPA Supervisor
Date
(please PRINT name and sign)
Other senior staff member
Date
(please PRINT name and sign)
Head of Department
Date
(please PRINT name and sign)
Comments by trainee:
Signature
Registrar/Deputy Registrar, Board of Censors
23 February 2016
Date
Page 4 of 4