Supervisor’s Report for Trainees in Oral and Maxillofacial 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.
Thank you
23 February 2016
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THE ROYAL COLLEGE OF PATHOLOGISTS OF AUSTRALASIA
Supervisor’s Report for Trainees in Oral and Maxillofacial Pathology
Name of Trainee (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  ……………… hours per week
Leave (taken or planned within this training period
Annual ……… weeks/days
Other ……… weeks/days (eg. Sick, Study, Parental, Maternity)
Sitting for RCPA examination this year?
No
Yes
(Please tick)
If yes:
Part I
Part II
Please see key on Page 1
A.
KNOWLEDGE BASE AND SKILLS
Autopsy Pathology
1.
No. of autopsies done/assisted:
During assessment period:
Adult _________
Paediatric and Neonatal: _________
Cumulative total:
Adult _________
Paediatric and Neonatal: _________
Please specify extent of involvement: ________________________________________
______________________________________________________________________
1
2
3
4
5
Quality of written reports (gross, micro,
final diagnosis)
____
____
____
____
____
3.
Autopsy clinicopathological correlation
____
____
____
____
____
4.
Ability to summarise relevant clinical
information and laboratory data
____
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5.
Verbal presentation of autopsy findings
____
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6.
Ability to complete reports within period
specified by Departmental policy
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Knowledge and use of special stains
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2.
7.
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Surgical Pathology
1.
2.
3.
ESTIMATE OF NUMBER OF BIOPSY CASES REPORTED
1.1
During assessment period:
General: _______
Oral: _______
1.2
Cumulative total:
General: _______
Oral: _______
NUMBER OF FROZEN SECTIONS
2.1
During assessment period:
General: _______
Oral: _______
2.2
Cumulative total:
General: _______
Oral: _______
2
3
4
5
2.3
Selection of blocks for frozen sections
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2.4
Ability to make diagnosis
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2.5
Communication with surgeons
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2.6
Ability to cut and stain frozen
sections
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1
2
3
4
5
GROSS SPECIMENS
3.1
Gross description and block selection
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3.2
Gross description of teeth and block
selection
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Gross description of resected jaws and
block selection
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1
2
3
4
5
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Knowledge and use of appropriate
ancillary techniques (eg. special
stains, immunohistochemistry), ground
and decalcified sections of teeth and jaws. ____
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Follow-up and completion of assigned task ____
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3.3
4.
1
MICROSCOPY
4.1
4.2
4.3
23 February 2016
Quality of descriptions and ability at
histological diagnosis
3
4.4
4.5
Interpretation of radiographs, CT scans
and other imaging techniques of teeth,
jaws and orofacial tissues.
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Quality of clinicopathological correlation
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Cytology
1.
Number of fine-needle aspirations (FNAs) performed and reported:
1.1
During assessment period:
General: _______
Oral: _______
1.2
Cumulative total:
General: _______
Oral: _______
1
2
4
5
Knowledge and use of cytological
preparatory techniques and their interpretation
(eg., cytospins, filters, cell blocks)
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Knowledge of criteria for satisfactory
and unsatisfactory specimens
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4.
Interpretive skills for exfoliative cytology
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5.
Performance and interpretative skills for FNAs
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6.
Knowledge and use of appropriate special stains
and special techniques (eg., immuno, EM)
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7.
Follow-up and completion of assigned tasks
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8.
Knowledge of clinical-cytopathological correlation,
clinical relevance of diagnosis, appropriate
follow-up required
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1
2
3
4
5
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1
2
3
4
5
2.
3.
3
Other
1.
Electron microscopy: applications, techniques,
interpretation
Research (where applicable)
1.
Knowledge of basic and clinical research
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2.
Capacity to analyse published research including
statistical analysis
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3.
Knowledge of special research techniques
____
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4.
Ability to prepare manuscript
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1
2
3
4
5
GENERAL REMARKS
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1.
Organisational skills
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2.
Presentation at clinical meetings
(eg. grand rounds)
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3.
Knowledge of current literature
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4.
Knowledge of laboratory management
and safety, and quality assurance
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5.
Attention to professional confidentiality
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B.
PROFESSIONAL ATTITUDES
1
2
3
4
5
1.
Interactive skills with:
1.1
Peers
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1.2
Supervisors
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1.3
Clerical and laboratory staff
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1.4
Clinicians
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2.
Confidence and initiative
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3.
Reliability
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4.
Ability to follow supervisor instructions
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5.
Does the trainee consult appropriately
when he or she needs help?
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Is the trainee receptive to new ideas?
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6.
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 ………….………………………………..
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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.
OTHER COMMENTS
(if insufficient space, please attach sheet)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
COMMENTS BY TRAINEE (IF INSUFFICIENT, PLEASE ATTACH SHEET):
23 February 2016
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___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Signatures
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
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Date
Date
Date
Date
Date