PG Cert SEQ submission:
Assessment Cover Sheet
Student Family Name:
Student First Name:
Student ID number:
Module Title & Code(s) :
New Trainer or
Date submitted:
Module 1 Supervision in the Workplace SS813
Module 2 Evidence Based Practice SS816
Module 3 Collaborative Working SS815
Existing Trainer:
I am submitting my work for consideration of the award PG certificate in Medical
Education and Strategic Leadership.
Please ensure you include the mandatory evidence in your submission (see below). You may elect to
submit a range of other evidence to support your academic submission and need to clearly indicate
which pieces of work you wish to contribute to your application for the PG cert on the form below.
SEQs are also used to support your trainer accreditation and some of the portfolio you provide for this
may not be relevant to the PG certificate and may not need to be listed (for example practice policy
documents)
PLEASE NOTE if your SEQ has comments from your Patch Associate Dean made as part of
your trainer accreditation these should be removed prior to submission.
Check list:
Modules:
Mandatory Evidence
Please confirm
evidence submitted
Yes / No
as appropriate
Module 1 Supervision in the Workplace
SS813
Module 2 Evidence Based Practice SS816
Module 3 Collaborative Working SS815
Module 2 Evidence Based Practice SS816
Self-Evaluation Questionnaire
YES / NO
8 point audit with reflection
YES / NO
Modules:
Other academic evidence (non –
mandatory)
Example only:
Module 1 Supervision in the workplace
SS813
Module 3 Collaborative Working SS815
Reflective critique on tutorial teaching
(with peer review)
Reflection on multidisciplinary learning
event
YES
YES