Supervisor’s Report
for Chemical Pathology
Please review the Trainee’s portfolio and logbook before completing this report
Name of Trainee (please print)
RCPA ID no.
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 was ___ weeks
Only required for Part II examinations
Supervisor RCPA ID no.
Arrangements made for supervision of training during
period of leave
_____________________________________________
_____________________________________________
23 February 2016
Please inspect the forms in the Trainee’s portfolio and use the Table below to record evidence of
completion
Portfolio forms
Minimum for
Part I pre-exam
Supervisor’s
report
2 different
techniques
Minimum for
Part II pre-exam
Supervisor’s
report
2 different
techniques
2 different
cases
2 different
cases
1 only
Not applicable
Clinical meetings attended (include
case lists)
Minimum 2 per
week
Minimum 2 per
week
Presentations at clinical meetings
Minimum 4 per
year
Minimum 4 per
year
all
all
Previous
total
Number in
current
year or
rotation
Cumulative
Total
Direct Observation / Practical Skill
(Dops)
Case-based discussion (CbD)
Safety checklist
Previous supervisor’s reports
Please inspect the Trainee’s logbook and use the Table below to record the number hours spent
on each activity.
Logged laboratory investigations, patients, teaching sessions
Previous
total
number
of hours
Routine automated
biochemistry
Stat or urgent biochemistry
Protein investigations
Hours in
current
year or
rotation
Cumulative
total hours
Minimum period
for Part I preexam
Supervisor’s
report
1 month
Minimum period
for Part II preexam
Supervisor’s
report
1 month
1 month
Metabolic and paediatric
biochemistry, trace elements
Specialised endocrine
biochemistry
Drug assay and toxicology
1 month
Genetic investigations and
molecular pathology
Patient consultations
1 month
Teaching sessions
23 February 2016
1 month
1 month
Minimum 1 per
week
Minimum 1 per
year
Minimum 1 per
week
Minimum 1 per
year
Please check Trainee’s logbook and use the Tables below to record the range of assays done and
instruments used
Instruments used (please refer to logbook)
Brief description of instrument used
Period when
used in previous
rotations
(weeks)
Period when
used in current
rotation (weeks)
Cumulative
use of
instrument
(weeks)
Period when
used in previous
rotations
(weeks)
Period when
used in current
rotation (weeks)
Cumulative
use of assay
(weeks)
Types of assays done (please refer to logbook)
Brief description of assays used
Professional qualities: e-Learning modules
Date completed
Please specify whether RCPA module or workplace training
Cultural competence
Ethics
Management
Quality
23 February 2016
For pre-examination supervisor’s reports:
Does the print-out of the portfolio summary spreadsheet accurately record the contents of the portfolio?
Yes
No
In the Table below, please score the Trainee’s performance using this scale during the current
assessment period
1 = Performance currently falls far short of expected standards
There is a serious problem that may have implications for accreditation
of the current training period. The problem must be clearly stated.
2 = Performance currently falls short of expected standards
There is an area of lower than expected performance for the level of
training.
3 = Performance is consistent with the expected level of training
About 80% of trainees will merit this grade.
4 = Performance is better than expected for level of training
About 10% of trainees will merit this grade.
5 = Performance is exceptional
Very few trainees will merit this grade.
N/A not applicable to this training period
Routine
automated
Biochem
Skill at bench level
Knowledge of method
principles
Ability to interpret results to
medical staff
Ability to interpret results to
lab staff
Participation in quality
assurance
Participation in trouble
shooting
Safe handling and
adherence to OHS
Time spent (specify days or
weeks)
Average lab workload
(samples per day)
23 February 2016
Stat or
urgent
Biochem
Metabolic
paediatric
trace
element
Endocrine
Biochem
Protein
investigations
Drug
assays
toxicology
Genetic
and
molecular
Score
(1-5)
Research
Knowledge of basic and clinical research
Capacity to analyse published research including statistical analysis
Knowledge of special research techniques
Ability to prepare a manuscript for publication
Professional attitudes and behaviours
Work organisation: time management, reliability, initiative. Prioritise, follow up, complete tasks
Attention to professional confidentiality, ethical standards, medico-legal obligations
Awareness of own limitations: consults when needs help, receptive to feedback & other views
Able to critically analyse current literature
Interactions with peers
Interactions with supervisors
Interactions with clerical and laboratory staff
Interactions with clinicians
Presentations at meetings (eg, grand rounds, clinical meetings)
Involvement in teaching/supervision
Overall evaluation
Areas of strength in professional practice (please summarise)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Areas for development in professional practice (please summarise)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Is specific further professional development required?
23 February 2016
Yes
No
If yes, please outline process
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
If a score of 1 or 2 is given please identify any specific issue that needs to be addressed with
respect to the trainee’s progress and/or the training environment. In this case the form must be
signed by the supervisor plus at least one senior colleague and a plan for remediation
attached.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Other comments (if insufficient space, please attach sheet)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Comments by trainee:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Signatures
23 February 2016
Trainee
(please PRINT name and sign)
RCPA designated supervisor
(please PRINT name and sign)
Other senior staff member/second Supervisor (if applicable)
(please PRINT name and sign)
Head of Department
(please PRINT name and sign)
Registrar/ Deputy Registrar Board of Censors
23 February 2016
Date
Date
Date
Date
Date