Peninsula Postgraduate Medical Education
Structured Training Report for ARCP – Intensive Care Medicine
Date of Planned ARCP: ……………………………………………………
The Faculty Tutor must complete this report, having reviewed the trainee’s learning portfolio and WPBAs
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Trainee’s Name
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NTN:
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College Ref No: |
GMC No: |
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Educational Supervisor and Faculty Tutor names
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Year of training to be assessed
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Dates: From To
ST year 3 4 5 6 7 (please circle) |
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Previous annual assessments |
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Dates |
Outcome |
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3 |
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4 |
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5 |
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Placements since last ARCP |
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Hospital |
Date from |
Date to |
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Current placement |
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Date from |
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Location |
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Specialty |
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Experience (please review evidence in portfolio) |
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Activity |
Date(s) |
Details |
Comments/Outcome |
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Log book review
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Specialty exams taken MRCP FRCA: Written Oral FFICM exam
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eg plan to take / retake
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please circle
Pass Fail
Pass Fail Pass Fail Pass Fail |
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How many school educational training days attended? |
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Courses |
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Presentations
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Publications
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Teaching Experience
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Administration/ Management
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Critical incidents
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Plaudits & Complaints
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GMC Survey
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Receipt No ………………. |
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Other achievements
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Summary of Training record
Trainee
Please attach a copy of the CCT ICM training record ( completed pages only)
Faculty Tutor to complete
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WBA Are there any issues regarding WBAs for this trainee?
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Top 30 cases? Is progress being made?
2 case summaries complete? |
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Progress Is the trainee making satisfactory progress towards completing ICM competencies?
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MSF or 360 Confirmation of satisfactory communication skills, attitudes and behaviour
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YES / NO (if no, add note)
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To be completed by Faculty Tutor
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Strengths of Trainee
Weaknesses of Trainee
Suggestions for improvement
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Strengths and weaknesses
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To be completed by Trainee
Do you have a mentor YES / NO
How many days sick leave have you had over the last year? |
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Details of concerns/investigations: |
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Are you aware if this trainee has been involved in any conduct, capability or Serious Untoward Incidents/ Significant Event Investigation or named in any complaint?
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Yes/ No |
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If so are you aware if it has/ these have been resolved satisfactorily with no unresolved concerns about a trainee’s fitness to practice or conduct?
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Yes/No |
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Comments, if any:
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Personal Development Plan(this will be discussed with your Training Programme Director at your ARCP. Include partner specialty interest(s), plans for Step 2/3 training or OOPT, etc)
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We confirm that this is an accurate description and summary of this trainee's learning portfolio and WPBA, covering the period from ................. to ................
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| Faculty Tutor | Trainee |
| Name: | Name: |
| Signature: | Signature: |
| GMC Number: | GMC Number: |
| Date: | Date: |
When completed please send the following to: Jennifer Phillips
A. Two copies of this structured training report/educational supervisors report
B. Up to date curriculum vitae
C. Two copies of your logbook