APPLICATION FOR ACCREDITATION OF LABORATORY FOR TRAINING CANDIDATES IN ANATOMICAL PATHOLOGY Please refer to policies when preparing your application. All information will be treated with strictest confidence by the Board of Education and Assessment (BEA) Note: No application will be considered without the following: (1) Attachment of a Training Program with detail of progression through the 5 years of training. (2) Detail of how competency will be maintained in areas not adequately covered in the training lab. Please complete all sections of this form, sign and return to College. Lab Name: Address: Area Health Service / District Health Board (if applicable): Telephone (switch): Fax: Contact person for application? Date: Email: Telephone (direct): RCPA ID No (if applicable – refer to RCPA lab accreditation letter): Director / Departmental Head of Laboratory Service: If applicable, Director / Departmental Head of Anatomical Pathology Laboratory Service Accreditation (NATA, IANZ, IS015189) Is the Anatomical Pathology Laboratory accredited? Discipline category (if relevant) Accreditation agency? Current accreditation period From: External proficiency program(s) List program(s) that the laboratory currently participates in (RCPA/ QAP; EMQN; CAP; etc) Supervision Supervisor(s) of Trainees Document Number: 1 Document Name: Anatomical Lab Accreditation Application form Document Path: BOC - Lab accreditation - Forms - Current Accreditation application forms To: (if shared supervision, please indicate primary supervisor) Number of funded EFT Pathologist positions with the Anatomical Pathology Laboratory Service Pathologists, with their qualifications, contributing to the training program (add extra lines if required) Name Qualifications Scope(s) of practice Date of appointment % of week in laboratory Other medically qualified staff providing essential training (add extra lines if required) Name Qualifications Date of appointment % of week in laboratory Senior Scientific and Tech staff contributing to Trainee supervision (add extra lines if required) Name Qualifications Area of technical expertise NOTE: The RCPA should be informed of any periods of extended absence, long service leave or sick leave of the supervisor/s. To ensure ongoing continuity of training the RCPA must be informed of the relief arrangement. Anatomical Pathology Trainees Please indicate the number of trainees you wish to accommodate at any one time Duration of Training considered appropriate (in years)? Please note It is College policy to limit training in one institution* to a maximum of four years. Document Number: 2 Document Name: Anatomical Lab Accreditation Application form Document Path: BOC - Lab accreditation - Forms - Current Accreditation application forms Number of current trainees Total no. trainees over past 5 years Summary details of current and past trainees exposed to Anatomical Pathology training Name Discipline Year training started Duration of Anatomical Pathology training? Exam progress? Training facilities Comments (if applicable) Professional Journals/ Library Computer/ Internet facilities Other (e.g. learning and teaching aids, etc) Laboratory workload 1. Number of Surgical Pathology Reports per annum: 2. Number or proportion of complex cases (eg complexity 5 or above in reports) Please indicate below any area in which there is NOT sufficient material for training purposes: Area Bone & Cartilage Brain & Neural Breast Oral Endocrine ENT Eye Gastrointestinal Gynaecological & Obstetric Kidney Liver Lung Document Number: 3 Document Name: Anatomical Lab Accreditation Application form Document Path: BOC - Lab accreditation - Forms - Current Accreditation application forms X Lymphomas Muscle Paediatric Prostate Skin Soft tissue Number of frozen sections per annum: Number of autopsies per annum: Adult Child Perinatal Coronial Number of diagnostic Cytology per annum: Gynaecological Fine needle aspiration Other *To ensure that candidates for RCPA qualifications are exposed to more than one style and philosophy of pathology practice, they are ordinarily limited to spending a maximum of 4 years training in one laboratory. Where the same members of a pathology service/practice supervise geographically separate laboratories, this may be viewed as training undertaken in a single laboratory and may not fulfil the College requirements for employment in a different institution unless significant differences in practice and supervision can be demonstrated. To assist the College in monitoring the above policy, please list all regular rotation arrangements below, specifying whether they are internal or external (i.e. to an operationally distinct service or geographically separate site with different management, practice and supervision). Please note that if Trainees participate in an external rotation, that site is required to be separately accredited. Discipline Site Type of Rotation Internal External Internal External Internal External Internal External Internal External Internal External Document Number: 4 Document Name: Anatomical Lab Accreditation Application form Document Path: BOC - Lab accreditation - Forms - Current Accreditation application forms Purpose of Rotation Please indicate any additional areas listed under the discipline check lists in the Trainee Handbook for which your laboratory is unable to provide training on site. Please state how these areas are/will be covered. Signature: ________________________________________ Date: _____________________ Completed application forms, together with all relevant training programs and other supporting documentation, should be forwarded to the Registrar at the Royal College of Pathologists of Australasia. You will be advised of your accreditation status following the next meeting of the Board of Education and assessment (BEA)/ and or determination by the Chief Examiner. Email to lab@rcpa.edu.au fax to +61 2 8356 5828 or mail to RCPA, 207 Albion Street, Surry Hills NSW 2010 Australia. Thank you for your support of pathology training. PLEASE NOTE THAT YOUR APPLICATION WILL NOT BE ACCEPTED WITHOUT A TRAINING PROGRAM Document Number: 5 Document Name: Anatomical Lab Accreditation Application form Document Path: BOC - Lab accreditation - Forms - Current Accreditation application forms