Trainee Assessment Record (TAR) - Form 1

You are required to complete and submit the below form once every six months over the course of your training.

This online form will be automatically submitted to the AGES Secretariat.

Trainee*
Prefix First Last
Gender
Date of Birth*
DD slash MM slash YYYY
Semester*
Semester Start Date*
DD slash MM slash YYYY
Semester End Date*
DD slash MM slash YYYY
Training Director*
Prefix First Last
Training Unit*
Training Supervisors
Weekly Timetable
The Timetable below is for recording your typical 4-weekly timetable of activities. Please complete all boxes with one (or more) of the following abbreviations: If there is a significant change in the training program during the six-month period, please indicate this by producing an additional Weekly timetable for the period.
Monday AM
Monday AM Week 1
Monday AM Week 2
Monday AM Week 3
Monday AM Week 4
Monday PM
Monday PM Week 1
Monday PM Week 2
Monday PM Week 3
Monday PM Week 4
Tuesday AM
Tuesday AM Week 1
Tuesday AM Week 2
Tuesday AM Week 3
Tuesday AM Week 4
Tuesday PM
Tuesday PM Week 1
Tuesday PM Week 2
Tuesday PM Week 3
Tuesday PM Week 4
Wednesday AM
Wednesday AM Week 1
Wednesday AM Week 2
Wednesday AM Week 3
Wednesday AM Week 4
Wednesday PM
Wednesday PM Week 1
Wednesday PM Week 2
Wednesday PM Week 3
Wednesday PM Week 4
Thursday AM
Thursday AM Week 1
Thursday AM Week 2
Thursday AM Week 3
Thursday AM Week 4
Thursday PM
Thursday PM Week 1
Thursday PM Week 2
Thursday PM Week 3
Thursday PM Week 4
Friday AM
Friday AM Week 1
Friday AM Week 2
Friday AM Week 3
Friday AM Week 4
Friday PM
Friday PM Week 1
Friday PM Week 2
Friday PM Week 3
Friday PM Week 4
Meetings, Presentations, Publications and Research
Meetings attended related to Gynaecological Endoscopy
Date Venue Meeting Name
Publications
Date Published Authors Title
Presentations
Date Presented Meeting Name Title
Research projects undertaken in this time
Research Title Supervisor Research Method Current Status Summary of research to current time
Clinical and Management Skills
Gynaecological endoscopists perform complex procedures that require more than practical experience. Their skill set draws on knowledge that underpins and informs their practice. Their practice is characterised by professional attitudes and behaviour, and they review and update this practice continually to ensure the highest possible standard of healthcare delivery. The following matrix describes the competencies that trainees are expected to achieve. Competency in procedural skills is assessed through workplace assessment. All clinical skills and processes are underpinned by sensitive, appropriate and effective communication with the patient and their significant others.
Definitions for TARs
Assisted at Procedure – Supervisor performed most of the surgery includes the supervising surgeon taking over for a period of time (more than 10 % of the operation)
Primary Surgeon Assisted - Trainee preformed most of the surgery with guidance by the supervising surgeon either by the surgeon taking over for a period of time (less than 10% of the operation allowed - more than 10% classifies as Assist at procedure) or providing descriptive advise on how to do the surgery ( more than 10% of case, < 10% classifies as unassisted)
Primary Surgeon Unassisted – Trainee performed all of the surgery without any guidance from the supervising surgeon (verbal guidance for < 10% of the case allowed) Note: If the complex part of the operation is performed by the supervisor (eg rectal nodule resected) then the trainee could classify the procedure as either Minimal endo primary surgeon unassisted or Advanced endometriosis assisted, as long as the above criteria is met.
Taught to Junior Staff – Assisted a junior staff member who was the primary surgeon. Junior staff member preformed most of the surgery with guidance without the trainee taking over (physical assistance for < 10% of the operation allowed)
Gynaecological Endoscopy Six-Month Clinical Training Summary
Laparoscopic Procedures
Peritoneal Surgery

Minimal/mild endometriosis (stage I/II) - Perform min. of 20 unassisted

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Moderate/ Severe endometriosis (Stage III/IV, including endometrioma) - Perform min. of 10 unassisted

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Advanced adhesiolysis (this is defined as adhesions requiring >45min to lyse) - Perform min. of 10 unassisted

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Ovarian Surgery

Ovarian cystectomy, oophorecetomy or salpingo-oophorectomy - Perform min. of 10 unassisted

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Ovarian Cysts - Perform min. of 10 unassisted

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Ovarian transposition - Perform under direct supervision

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Tubal Surgery

Salpingostomy and/or Salpingectomy for ectopic pregnancy - Perform min. of 10 unassisted

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Salpingectomy for sterilisation and/or for tubal pathology - Perform min. of 10 unassisted

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Tubal reanastomosis - Understand

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Neosalpingostomy and salpingoplasty - Understand

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Other tubal surgery

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Uterine Surgery

Laparoscopic hysterectomy - Perform min. of 20 unassisted

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Laparoscopic myomectomy - Perform min. of 10 unassisted

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Other uterine surgery

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Vaginal and Urogynaecological Surgery

Laparoscopic procedure for prolapse - Perform under direct supervision

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Laparoscopic procedure for incontinence - Perform under direct supervision

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Vaginal procedure for prolapse - Perform under direct supervision

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Vaginal procedure for incontinence - Perform under direct supervision

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Vaginal hysterectomy - Perform under direct supervision

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Abdominal Procedures

Abdominal hysterectomy

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Post partum hysterectomy

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Abdominal myomectomy

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Other abdominal surgery

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Hysteroscopic Procedures

Outpatient hysteroscopy - Perform under direct supervision

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Hysteroscopic treatment of myoma - Perform min. of 10 unassisted

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Hysteroscopic treatment of polyp - Perform min. of 10 unassisted

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Hysteroscopic septoplasty and hysteroscopic adhesiolysis - Perform min. of 10 unassisted

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Robotic Procedures
Robotic Proecdures - Understand
Understand (not perform) Direct Supervision Perform Unassisted
Urological Procedures

Diagnostic cystoscopy - Perform min. of 10 unassisted

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Ureteric catheterization (using straight catheters that are not left in the ureters for a prolonged time) - Perform min. of 10 unassisted

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Ureteric stenting (using double J stents that are placed for a prolonged time and require removal) - Understand
Understand (not perform) Direct Supervision Perform Unassisted
Ureteric reanastomosis - Understand
Understand (not perform) Direct Supervision Perform Unassisted
Colorectal Procedures
Sigmoidoscopy - Understand
Understand (not perform) Direct Supervision Perform Unassisted

Simple primary bowel repair after removal of small volume disease or immediate sharp injury - Perform under direct supervision

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Small bowel resection - Understand
Understand (not perform) Direct Supervision Perform Unassisted

Disc excision of rectosigmoid

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Colostopy / ileostomy creation / closure

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Left hemicolectomy/bowel resection for gynaecological disease (e.g. endometriosis)

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

Anterior resection of rectosigmoid

Primary Surgeon Assisted	Primary Surgeon Unassisted	Taught to Junior Staff	Assisted at this Procedure	Total exposure to this procedure over training semester	Total exposure to this procedure during AGES training

This report has been seen by me and discussed with the trainee.
Training Director Signature*
Trainee Signature*
Training Director Name*
First Last
Date*
DD slash MM slash YYYY
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Date	Venue	Meeting Name

Date Published	Authors	Title

Date Presented	Meeting Name	Title

Research Title	Supervisor	Research Method	Current Status	Summary of research to current time

Trainee Assessment Record (TAR) - Form 1

Weekly Timetable

Meetings, Presentations, Publications and Research

Clinical and Management Skills

Definitions for TARs

Gynaecological Endoscopy Six-Month Clinical Training Summary

Peritoneal Surgery

Ovarian Surgery

Tubal Surgery

Uterine Surgery

Vaginal and Urogynaecological Surgery

Abdominal Procedures

Hysteroscopic Procedures

Robotic Procedures

Urological Procedures

Colorectal Procedures