Supervisor’s Report for Trainees in Genetic Pathology
Information for Trainees and Supervisors
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It is the Trainee’s responsibility to ensure that this form is completed and submitted by the due
date. Failure to do so may jeopardise the accreditation of training time or finalisation of
examination results.
At least one Supervisor’s Report is due annually for all Trainees.
For Trainees who participate in rotational programs, one report should be completed for each
period of rotation at a different institution.
For Trainees sitting for Part I or Part II examinations, an additional pre-exam report is due by
15 July. Reports must be available for consideration at the viva examinations.
For all other Trainees, the Report must be submitted every year or, for rotations within a year, on
completion of each rotation. If the Trainee is not taking an examination, the annual Report may be
submitted with the annual registration for the subsequent year.
Trainees are advised to keep accurate records of work undertaken for the period of time spent in
each category of activity. A log book is an effective way in which this can be achieved. If precise
figures are unavailable, a best estimate should be given.
Trainees must keep a copy in their Training Portfolio of each year’s completed report. Please do
not contact the College for the previous year’s report.
Completing the form
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It is desirable that all specialists who supervise Trainees participate in the evaluation process and
completion of the form.
Supervisors are asked to rank the performance in each area of activity even if the time spent in it
is small. If there has been no exposure to a particular activity please write “Not Applicable” across
the space allocated for ranking.
Performance for skills in each area of training listed in the form should be assessed on a sliding
scale of 1 to 5 as indicated below.
1 = Performance currently falls far short of expected standards for level of training.
There is a serious problem that may have implications for accreditation of the current training
period. The problem must be stated clearly on the final page.
2 = Performance currently falls short of expected standards for level of training.
There is an area of lower than expected performance. The problem must be stated clearly on
the final page.
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.
Please return this form by the due date above, by mail to:
The Royal College of Pathologists of Australasia
207 Albion Street
Surry Hills NSW 2010 AUSTRALIA
Faxed reports will not be accepted.
Document Number: D130556
1
Document Name: Supervisor S Report - Genetics (Feb 2016 - Template).Docx
Document Path: BOC - 2012 - Supervisor's Reports (Pro Formas)
Thank you
THE ROYAL COLLEGE OF PATHOLOGISTS OF AUSTRALASIA
Supervisor’s Report for Trainees in Genetic Pathology
Name (Please print): ________________________________________________ RCPA ID No ______
Organisation: _____________________________________________________________
Year of Training:
1
2
3
4
5
6
7
Training Period:
______/______/__________ to ______/______/__________
(Please provide full and accurate dates for accreditation of training)
 Full Time or
 Part Time
Leave (taken or planned within this
training period
Specify hours per week employed
 Annual
_____ weeks or _____days
 Study leave
_____ weeks or _____days
 Sick leave
_____ weeks or _____days
 Parental/maternity
_____ weeks or _____ days
Please see key on page 1
1 CYTOGENETICS - mark X in box if section #1is not relevant to assessment period
, now go to section #2
A General
•
Experience in cell culture and chromosome banding:
_________ cases
•
Experience in karyotyping and reporting:
Normal
_________ cases
Abnormal
_________ cases
Variant
_________ cases
•
Give details of databases and analytic software programs utilised during this training period e.g.
OMIM, GDB etc:
______________________________________________________________________________
______________________________________________________________________________
• Experience in specimen preparation
1
2
3
4
5
n/a
• Experience in cell culturing
1
2
3
4
5
n/a
• Familiarity with ISCN1995
1
2
3
4
5
n/a
• Participation in quality assurance
1
2
3
4
5
n/a
23 February 2016
B Constitutional cytogenetic diagnosis
•
Time spent in this area during assessment period: ______ weeks
•
No. of specimens examined ____________ cases
•
Give examples of cases in which the trainee was involved in undertaking the test and reporting the
result:
•
Skills at bench level
1
2
3
4
5
n/a
•
Ability to interpret results
To referring doctor
1
2
3
4
5
n/a
To laboratory staff
1
2
3
4
5
n/a
•
Knowledge of method principles
1
2
3
4
5
n/a
•
Participation in troubleshooting
1
2
3
4
5
n/a
C Prenatal cytogenetic diagnosis
•
Time spent in this area during assessment period: ____ weeks
•
No. of CVS specimens examined ________ cases
•
No. of amniotic fluid specimens examined _________ cases
•
Give examples of cases in which the trainee was involved in undertaking the test and reporting the
result:
______________________________________________________________________________
______________________________________________________________________________
•
•
•
Prenatal diagnosis result reporting:
Normal
__________ cases
Abnormal
__________ cases
Variants
__________ cases
Skills at bench level
Ability to interpret results
To referring doctor
1
2
3
4
5
n/a
1
2
3
4
5
n/a
To laboratory staff
1
2
3
4
5
n/a
•
Knowledge of method principles
1
2
3
4
5
n/a
•
Participation in troubleshooting
1
2
3
4
5
n/a
23 February 2016
D Fluorescence in situ hybridization (FISH) diagnosis
• Time spent in this area during assessment period: ___ weeks
• No. of specimens examined ________ cases
• Give examples of cases in which the trainee was involved in undertaking the test and reporting the
result:
• Skills at bench level
1
2
3
4
5
n/a
• Ability to interpret results
To referring doctor
1
2
3
4
5
n/a
To laboratory staff
1
2
3
4
5
n/a
• Knowledge of method principles
1
2
3
4
5
n/a
• Participation in troubleshooting
1
2
3
4
5
n/a
E Malignant tissue cytogenetic diagnosis
• Time spent in this area during assessment period: _____ weeks
• No. of specimens examined _______ cases
• Give examples of cases in which the trainee was involved in undertaking the test and reporting the
result:
• Skills at bench level
1
2
3
4
5
n/a
• Ability to interpret results
To referring doctor
1
2
3
4
5
n/a
1
2
3
4
5
n/a
To laboratory staff
• Knowledge of method principles 1
2
3
4
5
n/a
_______________________________________________________________________________________
F Performance as a “consultant pathologist”
• Overall, how would you rate the trainee’s performance in providing advice on cytogenetic problems.
1
2
3
4
5
n/a
Comments:
______________________________________________________________________________
______________________________________________________________________________
• How would you rate the trainee’s knowledge of protocols and/or diagnostic strategies which would
need to be followed in various cytogenetic scenarios
1
2
3
4
5
n/a
Comments:
______________________________________________________________________________
23 February 2016
______________________________________________________________________________
______________________________________________________________________________
• Rate the trainee’s knowledge of protocols and/or diagnostic strategies available for maternal
screening during pregnancy
1
2
3
4
5
n/a
Comments:
______________________________________________________________________________
______________________________________________________________________________
• Rate the trainee’s general knowledge of genetics and the molecular basis of disease
1
2
3
4
5
n/a
Comments:
______________________________________________________________________________
______________________________________________________________________________
2 BIOCHEMICAL GENETICS - mark X in box if section #2 is not relevant to assessment period , now go to
section #3
A General
• Give details of databases and analytic software programs utilised during this training period e.g.
OMIM, GDB etc:
______________________________________________________________________________
______________________________________________________________________________
• Participation in quality assurance 1
2
3
4
5
n/a
B Amino acid, organic acid and metabolites analysis
• Time spent in this area during assessment period: ___ weeks
• No. of samples studied ___ cases
• List the Analytical Instruments used:
______________________________________________________________________________
______________________________________________________________________________
• Give examples of the assays used:
______________________________________________________________________________
______________________________________________________________________________
23 February 2016
• Skills at bench level
1
2
3
4
5
n/a
To referring doctor
1
2
3
4
5
n/a
To laboratory staff
1
2
3
4
5
n/a
• Knowledge of method principles
1
2
3
4
5
n/a
• Participation in troubleshooting
1
2
3
4
5
n/a
• Ability to interpret results
C Protein and enzyme investigation (electrophoresis, immunochemistry, etc)
• Time spent in this area during assessment period: ____ weeks
• No. of samples studied _______ cases
• List the Analytical Instruments used:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
• Give examples of the assays used:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
• Skills at bench level
1
2
3
4
5
n/a
• Ability to interpret results
To referring doctor
1
2
3
4
5
n/a
To laboratory staff
1
2
3
4
5
n/a
• Knowledge of method principles
1
2
3
4
5
n/a
• Participation in troubleshooting
D Newborn screening
1
2
3
4
5
n/a
• Time spent in this area during assessment period: ___ weeks
• List the Analytical Instruments used:
______________________________________________________________________________
______________________________________________________________________________
• Give examples of the assays used:
23 February 2016
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
• Skills at bench level
1
2
3
4
5
n/a
• Ability to interpret results
To referring doctor
1
2
3
4
5
n/a
To laboratory staff
1
2
3
4
5
n/a
• Knowledge of method principles
1
2
3
4
5
n/a
• Participation in troubleshooting
1
2
3
4
5
n/a
E Molecular genetics investigation of metabolic disorders
• Fill out the relevant parts in the following Section 3
F Performance as a “consultant pathologist”
• Overall, how would you rate the trainee’s performance in providing advice on biochemical genetic
problems.
1
2
3
4
5
n/a
Comments:
______________________________________________________________________________
______________________________________________________________________________
• How would you rate the trainee’s knowledge of protocols and/or diagnostic strategies which would
need to be followed in various metabolic and biochemical genetics scenarios
1
2
3
4
5
n/a
Comments:
______________________________________________________________________________
______________________________________________________________________________
• Rate the trainee’s general knowledge of genetics and the molecular basis of disease
1
2
3
4
5
n/a
Comments:
______________________________________________________________________________
______________________________________________________________________________
23 February 2016
3 MEDICAL GENOMICS - mark X in box if section #3 is not relevant to assessment period , now go to
section #4
A General
• List the Analytical Instruments used:
______________________________________________________________________________
______________________________________________________________________________
• Give examples of the assays used:
______________________________________________________________________________
______________________________________________________________________________
• Comment on trainee’s ability to undertake linkage analysis:
______________________________________________________________________________
______________________________________________________________________________
• Give details of databases and analytic software programs utilised during this training period e.g.
S-link, OMIM, GDB etc
• Participation in quality assurance 1
2
3
4
5
n/a
B Diagnostic testing e.g. haemochromatosis DNA test to confirm a raised ferritin
• Time spent in this area during assessment period: ______ weeks
• Samples processed:
name of disorder:
______ cases
name of disorder:
______ cases
name of disorder:
______ cases
• Skills at bench level
1
2
3
4
5
n/a
• Knowledge of method principles
1
2
3
4
5
n/a
• Ability to interpret results
To referring doctor
1
2
3
4
5
n/a
To laboratory staff
1
2
3
4
5
n/a
• Participation in troubleshooting
1
2
3
4
5
n/a
23 February 2016
C Carrier detection (this includes screening high risk and targeted population groups)
• Time spent in this area during assessment period: ______ weeks
• Samples processed: name of disorder:
______ cases
name of disorder:
______ cases
name of disorder:
______ cases
• Skills at bench level
1
2
3
4
5
n/a
• Knowledge of method principles
1
2
3
4
5
n/a
• Ability to interpret results
To referring doctor
1
2
3
4
5
n/a
To laboratory staff
1
2
3
4
5
n/a
• Participation in troubleshooting
1
2
3
4
5
n/a
D Prenatal diagnosis
• Time spent in this area during assessment period: ______ weeks
• Samples processed: name of disorder:
______ cases
name of disorder:
______ cases
name of disorder:
______ cases
• Skills at bench level
1
2
3
4
5
n/a
• Knowledge of method principles
1
2
3
4
5
n/a
• Ability to interpret results
To referring doctor
1
2
3
4
5
n/a
To laboratory staff
1
2
3
4
5
n/a
• Participation in troubleshooting
1
2
3
4
5
n/a
E Presymptomatic (predictive) testing e.g. Huntington and other adult-onset disorders
• Time spent in this area during assessment period: ______ weeks
• Samples processed: name of disorder:
______ cases
name of disorder:
______ cases
name of disorder:
______ cases
• Skills at bench level
1
2
3
4
5
n/a
• Knowledge of method principles
1
2
3
4
5
n/a
• Ability to interpret results
To referring doctor
1
2
3
4
5
n/a
23 February 2016
To laboratory staff
1
2
3
4
5
n/a
• Participation in troubleshooting
1
2
3
4
5
n/a
F Cancer genetics
• Time spent in this area during assessment period: ______ weeks
• Samples processed: name of disorder:
______ cases
name of disorder:
______ cases
name of disorder:
______ cases
• Skills at bench level
1
2
3
4
5
n/a
• Knowledge of method principles
1
2
3
4
5
n/a
• Ability to interpret results
To referring doctor
1
2
3
4
5
n/a
To laboratory staff
1
2
3
4
5
n/a
• Participation in troubleshooting
1
2
3
4
5
n/a
G Performance as a “consultant pathologist”
• Overall, how would you rate the trainee’s performance in providing advice on medical genomics
problems.
1
2
3
4
5
n/a
Comments:
______________________________________________________________________________
______________________________________________________________________________
• How would you rate the trainee’s knowledge of protocols and/or diagnostic strategies which would
need to be followed in various medical genomics scenarios
1
2
3
4
5
n/a
Comments:
______________________________________________________________________________
______________________________________________________________________________
• Rate the trainee’s general knowledge of genetics and the molecular basis of disease
1
2
3
4
5
n/a
Comments:
______________________________________________________________________________
______________________________________________________________________________
23 February 2016
4 CLINICAL EXPERIENCE - mark X in box if section #4 is not relevant to assessment period , now go to section #5
• Time spent in this area during assessment period: _______ estimate this in days
• Did the trainee have an opportunity to participate in genetic counseling / patient management
sessions
Yes No (circle)
• Cases involved in counseling:
• Cases involved in patient management:
name of disorder
____ cases
name of disorder
____ cases
name of disorder
____ cases
name of disorder
____ cases
name of disorder
____ cases
name of disorder
____ cases
• Average number of clinician enquiries
____ approx number per week
• Clinical knowledge
1
2
3
4
5
n/a
• Rapport with patients
1
2
3
4
5
n/a
• Rapport with clinical staff
1
2
3
4
5
n/a
• Rapport with other health workers 1
2
3
4
5
n/a
5 MANAGEMENT SKILLS - mark X in box if section #5 is not relevant to assessment period
, now go to section #6
• Leadership and supervision
1
2
3
4
5
n/a
•Approach to quality assurance issues
1
2
3
4
5
n/a
• Computing skills
1
2
3
4
5
n/a
• Organisational skills
1
2
3
4
5
n/a
_______________________________________________________________________________
6 TEACHING ABILITY - mark X in box if section #6 is not relevant to assessment period
•Teaching load during this assessment period:
____
Tutorials
____
Lectures
, now go to section #7
• Level of teaching: Laboratory Trainees / Undergraduate Medical / Post Graduate (circle)
• Knowledge of subject:
1
2
3
4
5
n/a
• Rapport with students:
1
2
3
4
5
n/a
• Presentation skills:
1
2
3
4
5
n/a
23 February 2016
7 RESEARCH ABILITY - mark X in box if section #7 is not relevant to assessment period
• Knowledge of basic and
clinical research
, now go to section #8
1
2
3
4
5
n/a
• Capacity to analyse published
research data including statistical analysis 1
2
3
4
5
n/a
• Ability to prepare research manuscript
2
3
4
5
n/a
1
• Attach a copy of papers and abstracts accepted for publication during this assessment period
_______________________________________________________________________________
8 GENERAL REMARKS & COMMENTS - answer section 8 for all periods of supervised training
• Organisational skills
1
2
3
4
5
• Motivation
1
2
3
4
5
• Ability to set up new assays
1
2
3
4
5
• Confidence and initiative
1
2
3
4
5
• Reliability
1
2
3
4
5
• Ability to follow supervisor’s
instructions
1
2
3
4
5
n/a
• Is the trainee receptive to new ideas?
1
2
3
4
5
_______________________________________________________________________________
9 PROFESSIONAL ATTITUDES & SKILLS - answer section 8 for all periods of supervised training
• General interactive skills with
Peers
1
2
3
4
5
Supervisors
1
2
3
4
5
Laboratory and clerical staff
1
2
3
4
5
Clinicians
1
2
3
4
5
Other health professionals
1
2
3
4
5
External customers
1
2
3
4
5
• Presentation at clinical meetings
1
2
3
4
5
• Knowledge of current literature
1
2
3
4
5
• Attention to professional ethics
1
2
3
4
5
• Does the trainee consult appropriately
when he/she needs help?
1
2
3
4
5
23 February 2016
Completion of professional qualities e-Learning modules ((please specify whether RCPA online
module or workplace training)
• Cultural competence
date completed ………….………………………………..
• Ethics
date completed ………….………………………………..
• Management
date completed ………….………………………………..
• Quality
date completed ………….………………………………..
_______________________________________________________________________________
10 OVERALL EVALUATION - give an overall rating by placing an X in the appropriate box, AND identify areas of strength
as well as areas of weakness in professional practice (please summarise and add attach pages if necessary)
C.
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: _______________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
23 February 2016
OTHER COMMENTS
(if insufficient space, please attach sheet)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
COMMENTS BY TRAINEE:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Signatures
Trainee
Date
(please PRINT name and sign)
RCPA designated supervisor
Date
(please PRINT name and sign)
Other senior staff member/second Supervisor (if applicable)
Date
(please PRINT name and sign)
Head of Department
Date
(please PRINT name and sign)
Registrar/ Deputy Registrar Board of Censors
23 February 2016
Date