Cert Medical Oncology(SA) - The Colleges of Medicine of South Africa
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CMSA PORTFOLIO OF LEARNING for admission to the Sub-specialty in Medical Oncology of the College of Paediatricians of South Africa CERT MEDICAL ONCOLOGY(SA) CRITICAL PERFORMANCE PORTFOLIO CONTENTS SECTION 1 Objectives of the CRITICAL PERFORMANCE PORTFOLIO SECTIO N 2 Syllab us fo r the Examinatio n o f the Cert Med Onco lo gy(SA) SECTIO N 3 T r aining Ob j ectives fo r the 2 -year Ro tatio n in P aed iatric Onco lo gy SECTIO N 4 Cand id ate Details SECTIO N 5 Reco r d o f Outp atient Attend ances SECTIO N 6 Reco r d o f Ad missio ns SECTIO N 7 Reco r d o f P ro ced ures Do ne SECTIO N 8 Reco r d o f Interviews SECTIO N 9 Attend ance at Meetings / Lectures / Symp o sia SECTIO N 1 0 Read ing and Research SECTIO N 1 1 B iannual Clinical P ractice Rating and Evaluatio n B ia nnual Reflective Summary SECTIO N 1 2 Reco r d o f Attachments SECTIO N 1 3 Declar atio n o n Co mp letio n o f T raining SECTION 1 OBJECTIVES OF THE CRITICAL PERFORMANCE PORTFOLIO What is a CRITICAL PERFORMANCE PORTFOLIO? The Certified Record of In-service Training Including Continuous Assessment and Learning (“CRITICAL” Portfolio) is a professional resource document structured in a flexible format allowing candidates to plan and meet the objectives of the Sub -specialty Trainee Training Programme through a process of reflection and documentation. T he p r imar y p ur p o se o f the CRIT ICAL P erfo rmance P o rtfo lio is to stimulate reflectio n o n tr aining, which sho uld ultimately assist in d irecting and extend ing o verall lear ning. A seco nd ar y p urp o se is to help d o cument the sco p e and d ep th o f the cand id ate’s tr aining exp er iences. A third imp o rtant functio n is to p ro vid e a b asis fo r d iscussio n with the cand id ate’s sup erviso rs ab o ut wo rk p erfo rmance, o b j ectives, and immed iate and futur e ed ucatio nal need s. It sho ul d co ntain the cand id ate’s written reflectio ns and systematic d o cumentatio n o f his/her training exp erience. A CRI T I CAL P er fo r mance P o rtfo lio is no t j ust a lo gb o o k o f signed p ro ced ures und ertaken o r witnessed . T he CRIT ICAL P o rtfo lio mo ves far b eyo nd this t o includ e o p p o rtunities fo r cand id ates to reflect, to exp lo re, to fo rm o p inio ns, and to id entify the str engths and weaknesses in his/her o wn ab ilities and kno wled ge. In this way the P o rtfo lio p r o vid es an o utlet fo r d o cumenting the sub j ective asp ects o f tr aining. The objectives of maintaining a CRITICAL Performance Portfolio are to: d evelo p a str uctur ed lear ning p lan id entify go als and actio ns r eq uired in that learning p lan reco r d p r o gr ess in achieving tho se go als d o cument p er so nal str engths id entify ar eas need ing imp r o vement reflect o n p r o gr essive p r o fessio nal d evelo p ment enco ur age q uality two -way co mmunicatio n with sup erviso rs p ro vid e a p r o -active p lanning p ro cess p ro vid e d o cumentatio n fo r the co ntinuo us evaluatio n, review and mento ring o f the cand id ate Who lo o ks a t t he CRITICAL Perfo rma nce Po rtfo lio ? The primary audience for the CRITICAL Performance Portfolio is the candidate. It is as useful as the effort put into it. Other than the candidate, supervisors are encouraged to review the candidate’s pr ogress and to refer to entries in the Portfolio as a basis for discussion. It is expected that candidates formally meet with their supervisor several times during each rotation. Ideally, relevant parts of the Portfolio should be made available to the sup ervisor before each meeting, thereby providing structure to the supervision process, and providing constructive advice with regard to problems and deficiencies. CRITICAL Perf o rma nce Po rt f o lio Co mpletio n Criteria T he P er fo r mance P o r tfo lio sho uld always b e used in co nj unctio n with the Reg ula t io ns and Sy lla bus fo r ad missio n to the Sub -sp ecialty o f the Co llege o f P aed iatr icians o f So uth Africa (Cert Med Onco lo gy(SA)), as may b e amend ed fro m time to time. Entr ies must at all times b e leg ible and , where ind icat ed , sup p o rted b y the req uir ed sig na t o ries ( Sup ervising Co nsultants and Head s o f Dep artments and their co ntact d etails) . Ad d p ages to each Sectio n as necessary. Ensure that yo ur name ap p ear s o n ever y p age. It is stro ng ly a dv ised that yo u keep an electro n ic b ackup co p y o f all entr ies, as well as a p rinted co p y, in case o f co mp uter failure o r theft. Each Ro tatio n will need to b e verified b y the relevant Head o f Dep artment, includ ing the co mp leted “ Reco rd o f Pro cedures Do ne ” and “Clinica l Pra ctice Ra t ing a nd Ev a lua t io n ” fo r each Ro tatio n. T he P o r tfo lio and sup p o r ting Certificates and P ub licatio ns must reach the Acad emic T r ainee o f the Co lleges o f Med icine o f So uth Africa (to gether with the relevant assessment fee, if ap p licab le) a t lea st 3 (three) m o nths p rio r to the co mmencement o f the Cer t Med Onco lo gy(SA) Final Examinatio n. Failure to sub mit the P o r tfo lio b efo r e this time will result in the cand id ate no t b eing invited to the Examinatio n. T he Decla ra t io n ( Sectio n 1 3 ) must b e signed b efo re sub mitting the P o r tfo lio to the Co llege. T his P o r tfo lio is a guid e and cumulative reco rd o f yo ur p erso nal learning, need s, o b j ectives, str ategies and activities thro ugho ut yo ur Sub -sp ecialty T rainee training p ro gramme. T he Sectio ns in the P o rtfo lio are no t exhaustive, b ut rather an ind icatio n o f the minimum that yo u sho uld b e d o ing. Yo u will learn a great d eal mo re than what is written o n these p ages. W e trust that this will p ro vid e yo u with a p o sitive and valuab le lear ning exp er ience. SECTION 2 SYLLABUS FOR THE FINAL EXAMINATION OF THE CERT MED ONCOLOGY(SA) Link to the latest electronic copy of the Cert Medical Oncology(SA) Paed Regulations hosted on The Colleges of Medicine of South Africa Website The following syllabus is a study guide in preparation for the Final Examination of the Cert Med Oncology(SA). It is intended only as a guide to the major topics, and any aspect relevant to the basic science and clinical practice of the sub-specialty can be examined. SYLLABUS AND TRAINING (all specifically related to childhood cancer) Paediatric Oncology Curriculum – General Principles 1. Gener al p rincip les o f ep id emio lo gy 2. Ap p licatio n o f mo lecular b io lo gy in child ho o d cancer and r elated illnesses 3. Genetic and enviro nmental facto rs in child ho o d cancer 4. T he haemato p o ietic system with sp ecial reference to stem cell, mar r o w turno ver and haemato p o iectic gro wth facto rs 5. B asic tumo ur b io lo gy: 6. P atho lo gy relevant to clinical p ractice 7. T umo ur imaging 8. P r incip les o f staging 9. P r incip les o f chemo therap y immuno lo gy tumo ur kinetics gro wth facto rs o nco genes 1 0 . T he r o le o f surgery in cancer treatment 1 1 . B asic p r in cip les o f rad iatio n treatment and the ro le o f rad iatio n ther ap y in cancer treatment 1 2 . B o ne mar ro w transp lantatio n, stem cell rescue and co rd b lo o d tr ansp lants 1 3 . Statistical p rincip les, metho d s o f research and co nd uct o f clinical tr ials 1 4 . Ethics o f cancer treatment and clinical trials A comprehensive approach to diagnosis and management of specific tumour types: 1. Acute lymp ho b lastic leukaemia 2. Acute no n -lymp ho b lastic leukaemias 3. No n Ho d gkin lymp ho ma 4. Ho d gkin lymp ho ma 5. Chr o nic leuka emia and myelo d ysp lastic synd ro mes in child ho o d 6. Centr al ner vo us system tumo urs 7. W ilms’ tumo ur and o ther renal malignancies o ccurring in child ho o d 8. Neur o b lasto ma 9. Hep ato b lasto ma and o ther liver malignancies o ccurring in child ho o d 10. Rhab d o myo sar co ma and o ther so ft tissue sarco mas 11. Osteo genic sar co ma 12. Ewing’s sar co ma 13. P er ip her al neur o ecto d er mal tumo urs 14. Retino b lasto ma 15. Ger m cell tumo ur s 16. End o cr ine tumo ur s 17. Histio cytic synd r o mes includ ing Langerhans cell and familial histio cyto sis 18. AI DS and child ho o d cancer Supportive Care of Children with Cancer 1. Onco lo gic emer gencies: SVC synd ro me co rd co mp ressio n end o crine and metab o lic d isturb ances 2. Haemato lo gic sup p o r tive care 3. I nfectio us co mp licatio ns and t heir management 4. Nutr itio n in the child o n cancer treatment 5. P r incip les o f p sycho so cial sup p o rt fo r the p atient and family 6. Anti-emetic ther ap y 7. P ain co ntr o l 8. P alliative/ter minal car e 9. Late effects o f child ho o d cancer and its treatment 10. Effective use o f r eso ur ces SECTION 3 TRAINING OBJECTIVES FOR THE 2-YEAR ROTATION IN PAEDIATRIC ONCOLOGY T o b e r ead in co nj unctio n with Sectio n 2 o f this P o rtfo lio (Syllab us fo r the Examinatio n o f the Cer t Med Onco lo gy(SA)), and Sectio ns 5 ,6 ,7 and 8 (Reco rd o f Outp atient Attend ances, Ad missio ns, P ro ced ures and Interviews) T he tr aining sho uld aim to eq uip the cand id ate with the necessary skills and kno wled ge to manage all asp ects o f clinical p aed iatric o nco lo gy. In ad d itio n to treating child ho o d malignancy the cand id ate wo uld b e exp ected to b e ab le to [1 ] resear ch co mp lex cases and co o rd inate multid iscip linary management. [2 ] aud it r esults and manage tr eatment p ro to co ls. [3 ] p lan and manage o nco lo gy services. [4 ] ed ucate nur sing and med ical staff. As such the tr aining o b j ectives o f the cand id ate sho uld b e to : [1 ] Develo p a so lid clinical gro und ing in p aed iatric o nco lo gy thro ugh p ractical exp erience. [2 ] Master the r eq uisite clinical skills, includ ing such p ro ced ures as b o ne ma rro w b io p sies and intr athecal ad ministratio n o f chemo therap y. [3 ] B uild a so und kno wled ge b ase via read ing, b ed sid e teaching, tuto rials, tumo ur b o ard d iscussio ns and j o ur nal club meetings. [4 ] Develo p their co mmunicatio n skills with b o th p atients and p ar ents, as well as fello w health p r o fessio nals. [5 ] T ake p ar t in r esear ch activity. SECTION 4 CANDIDATE DETAILS SURNAME:…………………………………………………………………………………………. FIRST NAMES:…………………………………………………………………………………….. ID NUMB ER:…………………………………………………………………………………… …... HP CSA NUMB ER:…………………………………………………………………………………. T RAINEE P OST NUMB ER:…………………………………………………………………… W ORK ADDRESS:………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… RESIDENT I AL ADDRESS:…………… …………………………………………………………. ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… P REFERRED P OST AL ADDRESS:…………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… EMAIL ADDRESS:…… ………………………………………………………………………….. T ELEP HONE NUMB ER: ( W o r k):……………………………….(Ho me):…………………….. CELLP HONE NUMB ER:…………………………………………………………………………. FAX NUMB ER:……………………………………………………………………………………. SPECIALIST MEDICAL QUALIFICATIONS UNIVERSI T Y:………………………………………………………YEAR :………………………. REGISTRAR TRAINING HOSP I T AL:…………………………………………………………YEAR:………………………. T RAINI NG EXP ERI ENCE:……………………………………………………………………….. ……………………………………………………………………………………………………….. ………………………………………………………………………………………………………. COMMUNITY SERVICE HOSP I T AL:……………………… …………………………………YEAR:………………………. T RAINI NG EXP ERI ENCE:……………………………………………………………………….. ………………………………………………………………………………………………………. ………………………………………………………………………………………………………. OTHER REGISTERABLE POST-GRADUATE QUALIFICATIONS DIP LOMA/DEGREE:………………………………………………YEAR:…… ………………… INST I T UT I ON:……………………………………………………………………………………… DIP LOMA/DEGREE:………………………………………………YEAR:……………………… INST I T UT I ON:……………………………………………………………………………………… ADDITIONAL POST-GRADUATE TRAINING EXPERIENCE (P rio r to co mmencement o f Sub -sp ecialty T rainee Ro ta tio n) ST AT US DAT ES HOSP I T AL DEP ART MENT COUNT RY DURAT ION ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… RELEVANT DETAILS / EXPERIENCE RELATING TO SUB-SPECIALTY TRAINING (P rio r to co mmencement o f Sub -sp ecialty T rainee Ro tatio n) ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… …………………………………………………………………… ………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… 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……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… Section 7 Candidate Name: Page No. of Pages ……… ………………………… ……………………………………………… ……… ……… ……… ……… ……… ……… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ……………………………………………… ……………………………………… ……… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……… ………………………… ……………………………………………… ……… ……… ……… ……… ……… ……… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……… ………………………… ……………………………………………… ……… ……… ……… ……… ……… ……… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ……………………………………………… ……………………………………………… …………………………………………… … ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……… ……… ……… ……… ……… ……… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ……………………………………………… ……………………………………………… 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Co ntact No :……………… SECTION 8 RECORD OF INTERVIEWS Date Diagnosis Nature of Interview ……… ………………………… ……………………………………………… ……… ……… ……… ……… ……… ……… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……… ………………………… ……………………………………………… ……… ……… ……… ……… ……… ……… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……… ………………………… ……………………………………………… ……… ……… ……… ……… ……… ……… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……… ………………………… ……………………………………………… ……… ……… ……… ……… ……… ……… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……… ………………………… ……………………………………………… ……… ……… ……… ……… ……… ……… ……… ……… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… ……………………………………………… SECTION 9 ATTENDANCE AT MEETINGS / LECTURES / SYMPOSIA Attend ance at Meetings, Lectur es, Symp o sia o r Co ngresses relevant to yo ur Sub sp ecialty. (Attach Certifica tes o f Atten d a n ce if ap p licab le) Date Event Details of Topic and / or Presenter ……….. ……….………. ……………………………………………………………….. ……….. ……….………. ……………………………………… ……………………….. ……….. ……….………. ……………………………………………………………….. ……….. ……….………. ……………………………………………………………….. ……….. ……….………. ……………………………………………………………….. ……….. ……….………. ……………………………………………………………….. ……….. ……….………. ……………………………………………………………….. ……….. ……….………. ……………………………………………………………….. ……….. ……….………. ……………………………………………………………….. ……….. ……….………. ……………………………………………………………….. Co mment o n key issues, take ho me messages, clinical relevance, and asp ects req uiring further p erso nal exp lo r atio n: ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… SECTION 9 ATTENDANCE AT MEETINGS / LECTURES / SYMPOSIA TUMOUR BOARD MEETINGS Date Diagnoses discussed ……….. ……….…………………..………………………………………………………….. ……….. ……….…………………..………………………………………………………….. ……….. ……….…………………..………………………………………………………….. ……….. ……….…………………..………………………………………………………….. ……….. ……….…………………..………………………………………………………….. ……….. ………. …………………..………………………………………………………….. ……….. ……….…………………..………………………………………………………….. ……….. ……….…………………..………………………………………………………….. ……….. ……….…………………..………………………………………………………….. ……….. ……….…………………..………………………………………………………….. ……….. ……….…………………..………………………………………………………… .. ……….. ……….…………………..………………………………………………………….. ……….. ……….…………………..………………………………………………………….. ……….. ……….…………………..………………………………………………………….. ……….. ……….…………………..………………………………………………………….. ……….. ……….…………………..………………………………………………………….. ……….. ……….…………………..…………………… …………………………………….. ……….. ……….…………………..………………………………………………………….. SECTION 10 READING AND RESEARCH LECTURES GIVEN B Y CANDIDATE: Date Topic Event …………. …………………………………. ………………………………………………. …………. …………………………………. ………………………………………………. …………. …………………………………. ………………………………………………. …………. …………………………………. ………………………………………………. …………. …………………………………. ………………………………………………. …………. …………………………………. ………………………………………………. …………. …………………………………. ………………………………………………. PAPERS PRESENTED B Y CANDIDATE: Date Topic Event …………. …………………………………. ………………………………………………. …………. …………………………………. ………………………………………………. …………. …………………………………. ………………………………………………. …………. …………………………………. ………………………………………………. …………. …………………………………. ………………………………………………. …………. …………………………………. ………………………………………………. …………. …………………………………. ………………………………………………. J O URNAL PUB LICATIO NS B Y CANDIDATE: (Attach 1 s t p age o f Ar ticle) Na me o f J o urna l Vo l. & No . Full Title Pa g es …………………………… …………. …………………………………………… ……….. …………………………… …………. …………………………………………… ……….. …………………………… …………. …………………………………………… ……….. …………………………… …………. …………………………………………… ……….. …………………………… …………. …………………………………………… ……….. RESEARCH INVO LVEM ENT B Y CANDIDATE : T yp e o f I nvo lvement / Details o f P ro j ect(s): ……………………………………………………………………………………………………… …………………………………………………………… ………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………… ……………… ……………………………………………………………………………………………………… Verified b y: Signatur e:……………………………………… Date:………………………… Name:…………………………………………. Co ntact No :…………………. JOURNAL CLUB PARTICIPATION: Date J o ur nals cited and T o p ics d iscussed : ………… …………………………………………………………… …………………………. ………………………………………………………………………………………. ………………………………………………………………………………………. ………… ………………………………………………………………………………………. ………………………………………………………………………………………. ………………………………………………………………………………………. ………… ………………………………………………………………………………………. …………………………………………… …………………………………………. ………………………………………………………………………………………. ………… ………………………………………………………………………………………. ………………………………………………………………………………………. ………………………………………………………………………………………. ………… ………………………………………………………………………………………. ………………………………………………………………………………………. ………………………………………………………………………………………. ………… ………………………………………………………………………………………. ………………………………………………………………………………………. ………………………………………………………………………………………. JOURNAL CLUB REVIEWS UNDERTAKEN BY CANDIDATE: Name o f J o ur nal Vo l. & No . Full T itle P ages …………………………… …………. …………………………………………… ……….. …………………………… …………. …………………………………………… ……….. …………………………… …………. …………………………………………… ……….. …………………………… …………. …………………………………………… ……….. …………………………… …………. …………………………………………… ……….. Co mment o n key issues, take ho me messages, clinical re levance, and asp ects req uiring further p erso nal exp lo r atio n: ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………… ……………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ANY O TH ER M ISCELLANEO US RELEVANT TO SUB - SPECIALTY: EXTRA - CURRICULAR LEARNING EXPERIENCE ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… …………………………………………………………………………… ………………………… SECTION 11 CLINICAL PRACTICE RATING AND EVALUATION T hese Evaluatio n Sheets must b e co mp leted b y the Cand id ate’s Sup erviso r d uring and at the end o f ea ch Ro tatio n, and b e discussed with the Cand id ate. Numb er the Sheets in chro no lo gical o r d e r . P erio d und er Review:……………………………………………………………………. Name o f Cand id ate’s Sup er viso r:……………………..………Co ntact No .:………… Signatur e o f Sup er viso r :……………..…………………………Date:………………… Date o f Co mmencement o f T r aineeship : …………………………………………… No te : Answer s to the fo llo wing q uestio ns sho uld b e given o n a scale o f 1 – 1 0 : 9 7 5 3 1 o r 1 0 = excellent o r 8 = ab o ve average o r 6 = average o r 4 = b elo w average o r 2 = weak CRITERIA 1. SCO RE (1 - 1 0 ) APPLIED CLINICAL K NO WLEDGE Current level o f kno wled ge ………… Use o f the med ical liter atur e ………… Evid ence -b ased p r actice ………… Co ntrib utio ns to acad emic meetings ………… Sectio n 1 1 Ca nd id a te Na m e: CRITERIA 2. 3. 4. Pa g e No . of Pa g es SCO RE (1 - 1 0 ) CLINICAL SK ILLS Clinical co mp etence ……….. T echnical / P r o ced ur al skills ……….. Co mmunicatio n skills ……….. PRO FESSIO NAL VALUES AND ATTITUDES Attend ance ……….. Reliab ility / Resp o nsib ility ……… Do cto r - p atient r elatio nship s ……… Relatio nship s with health care team ……… O VERALL ASSESSM ENT Glo b al Rating ……… Sp ecific co mments o n the str engths and weaknesses yo u have id entified regard ing this Cand id ate: …………………………………………………………………………………………….. …………………………………………………………………………………… ………… ……………………………………………………………………………………………… Verified b y Acad emic Head : Signature:…………………………….. Date:………………… Name o f Acad emic Head :………………….………………….. Co ntact No :…………………. Co mments b y Acad emic Head :…………………………………………………………………. ………………………………………………………………………………… …………………… ……………………………………………………………………………………………………… Sectio n 1 1 5. Ca nd id a te Na m e: Pa g e No . of REFLECTIVE SUM M ARY A reflective summar y sho uld b e co mp leted b iannually at the same time as the clinical evaluatio n. I t sho uld b e d iscussed with yo ur sup erviso r. Review attachments, p resentatio ns and cases o ver the last year. Cho o se three things illustrating ho w yo u have d evelo p ed as a clinician, teacher o r researcher. Reflect in d etail. Cho o se o ne o r two things that yo u wo uld have liked to includ e b ut haven’t yet managed to achieve. Co nsid er ho w they wo uld enhance yo ur p ro fessio nal d evelo p ment and ho w yo u are go ing to achieve them in the fo llo wing year. …………………………………………………………………………………………….. ……………………………………………………………………………………………… ……………………………………………………………………………………………… …………………………………………………………………………………………….. ……………………………………………………………………………………………… ……………………………………………………………………………………………… …………………………………………………………………………………………….. ……………………………………………………………………………………………… ……………………………………………………………… ……………………………… …………………………………………………………………………………………….. ……………………………………………………………………………………………… ……………………………………………………………………………………………… …………………………………………………………………………………………….. ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… Pa g es SECTION 12 RECORD OF ATTACHMENTS Rad io ther ap y, B o ne Mar r o w T r ansp lant, Haemato lo gy Lab o rato ry. Department Start Date End Date Supervisor ………………………………………. ……….. ……….. ………….….. ………………………………………. ……….. ……….. ………….… .. ………………………………………. ……….. ……….. ………….….. ………………………………………. ……….. ……….. ………….….. ………………………………………. ……….. ……….. ………….….. ………………………………………. ……….. ……….. ………….….. Co mment o n key issues, take ho me messages, clinical relevance, and asp ects req uiring further p er so nal exp lo r atio n: ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ………………………………………………………………………………… …………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… SECTION 13 DECLARATION ON COMPLETION OF TRAINING I, ……………………………………………………… …….hereb y d o so lemnly d eclare that all info rmatio n co ntained in this CRIT ICAL P ERFORMANCE P ORT FOLIO is a true and accurate reco rd of my p r o fessio nal exp erience, ed ucatio n and training fro m ………………. to ……………………… rep resenting the p er io d o f training fo r the Ce rt Med Onco lo gy(SA) q ualificatio n. Signatur e o f Cand id ate:………………………………………. Name o f Cand id ate:…………………………………………… T rainee Numb er :…………………………………………….. Date:…………………………………………………………….
