Specialist Advisory Committee in Endocrinology
SURVEY FORM FOR HOSPITALS WITH ADVANCED TRAINEES
IN ENDOCRINOLOGY
This survey is used by Specialist Advisory Committee (SAC) in Endocrinology to collect
background information about a site prior to conducting a site visit. The site should aim to
address the SAC’s Criteria for the Accreditation of Advanced Training Sites in Endocrinology
when filling out this form. The site visitors will be assessing your site by these guidelines.
Please type your response and return this form by email to Endocrinology@racp.edu.au
If necessary, you may print out this form and mail it to:
SAC in Endocrinology, Royal Australasian College of Physicians, 145 Macquarie St,
Sydney, NSW, 2000.
Name of advanced training site:
Date of last site visit:
Current accreditation status:
Name of site contact:
Name of head of department:
Contact address:
Contact telephone:
Contact fax:
Contact email:
Survey Form for Hospitals with Advanced Trainees in Endocrinology/SAC in Endocrinology
1
Number of endocrinologists
Please specify the name and number of endocrinologists (visiting, academic, full-time or
proportion of full-time) at the site.
Name:
Type of position:
Proportion of
full-time:
2
Number of inpatient beds with acute endocrine and diabetes admissions, which
are/will be managed by the advanced trainee:
3
Does the site have an inpatient consultation service in endocrinology?
YES
/ NO
Comments:
2
Survey Form for Hospitals with Advanced Trainees in Endocrinology/SAC in Endocrinology
4
Has the site established policies to permit direct involvement by the advanced
trainee in the management of acute endocrine emergencies?
YES
/ NO
Comments:
5
Describe the outpatient facilities in endocrinology available at the site?
What clinics will the advanced trainee be involved in?
Clinic name
Duration
(hours)
Comments:
3
No. of patients seen by registrar
New
Review
Survey Form for Hospitals with Advanced Trainees in Endocrinology/SAC in Endocrinology
6
Will the advanced trainee have exposure to current diagnostic testing protocols
and an opportunity for reporting endocrine diagnostic tests?
YES
/ NO
Comments:
7
Does the site have facilities for:
a)
nuclear medicine studies
YES
/ NO
YES
/ NO
YES
/ NO
YES
/ NO
Comments:
b)
radioactive iodine therapy
Comments:
c)
radiology
Comments:
d)
endocrine surgery
Comments:
4
Survey Form for Hospitals with Advanced Trainees in Endocrinology/SAC in Endocrinology
8
Does the site provide trainees with exposure to post-operative pituitary care?
YES
/ NO
Comments:
9
Does the site have a diabetes centre with diabetes educator staff, exposure to
insulin pump therapy and involvement in outpatient stabilisation?
YES
/ NO
Comments:
10
Does the site have an identified endocrinology department with office space for
the use of the advanced trainee?
YES
/ NO
Comments:
5
Survey Form for Hospitals with Advanced Trainees in Endocrinology/SAC in Endocrinology
11
Does the advanced trainee have access to a well-equipped library containing core
endocrine reference materials and journals and current general reference
material?
YES
/ NO
Comments:
12
Please outline the regular clinical and research meetings and journal club
meetings in endocrinology:
13
Does the advanced trainee attend formal clinical handover sessions at the site?
YES
/ NO
Comments:
6
Survey Form for Hospitals with Advanced Trainees in Endocrinology/SAC in Endocrinology
14
Please provide a weekly timetable for each trainee. The timetable should outline
what each trainee is doing each day. (Attach if necessary).
Position 1
Monday
Tuesday
Wednesday
Thursday
Friday
Tuesday
Wednesday
Thursday
Friday
am
pm
Position 2
Monday
am
pm
7
Survey Form for Hospitals with Advanced Trainees in Endocrinology/SAC in Endocrinology
15
Does the site provide opportunities for other core or non-core advanced training
positions in endocrinology which are not covered elsewhere on this form?
YES
/ NO
If yes, please provide a brief description of the positions:
If yes, please confirm that these positions do not impact upon the quality of
clinical exposure and supervision of the advanced trainees in any accredited RCY
and/or core training positions at the site:
8
Survey Form for Hospitals with Advanced Trainees in Endocrinology/SAC in Endocrinology
Facilities provided for training in these areas:
Type 1 Diabetes
16
Type 2 Diabetes
Gestational diabetes
Hyperthyroidism
Other thyroid diseases
Adrenal
Metabolic bone disease
Pituitary adenomas
Growth disorders
Paediatric endocrinol.
Menopause
Androgen replacement
Pituitary replacement
Obesity
Fertility
I131 therapy
Lipids/CV risk
Genetic endocrinology
Thyroid biopsy
Hormone implantation
Endocrine stimulation
I confirm that this is a true and accurate record at the time of signature and if any changes are
made in future that impact on the quality of training accredited I will advise the SAC in
Endocrinology of these changes.
Form completed and submitted by:
Name:
Signature:
Date:
9