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* TitleMr.Mrs.MissMs.Dr.Prof.A/Prof.Rev. Prefix First Last GenderMaleFemalePrefer not to answerDate of Birth* DD slash MM slash YYYY Semester*1234Semester Start Date* DD slash MM slash YYYY Semester End Date* DD slash MM slash YYYY Training Director* TitleMr.Mrs.MissMs.Dr.Prof.A/Prof.Rev. Prefix First Last Training Unit*Training Supervisors Weekly TimetableThe 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 AMMonday AM Week 1POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeMonday AM Week 2POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeMonday AM Week 3POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeMonday AM Week 4POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeMonday PMMonday PM Week 1POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeMonday PM Week 2POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeMonday PM Week 3POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeMonday PM Week 4POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeTuesday AMTuesday AM Week 1POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeTuesday AM Week 2POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeTuesday AM Week 3POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeTuesday AM Week 4POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeTuesday PMTuesday PM Week 1POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeTuesday PM Week 2POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeTuesday PM Week 3POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeTuesday PM Week 4POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeWednesday AMWednesday AM Week 1POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeWednesday AM Week 2POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeWednesday AM Week 3POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeWednesday AM Week 4POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeWednesday PMWednesday PM Week 1POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeWednesday PM Week 2POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeWednesday PM Week 3POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeWednesday PM Week 4POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeThursday AMThursday AM Week 1POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeThursday AM Week 2POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeThursday AM Week 3POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeThursday AM Week 4POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeThursday PMThursday PM Week 1POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeThursday PM Week 2POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeThursday PM Week 3POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeThursday PM Week 4POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeFriday AMFriday AM Week 1POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeFriday AM Week 2POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeFriday AM Week 3POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeFriday AM Week 4POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeFriday PMFriday PM Week 1POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeFriday PM Week 2POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeFriday PM Week 3POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeFriday PM Week 4POT: Public operating listVOT: Private operating listPGC: Public gynae clinicVGC: Private gynae clinicOC: ObstetricsUC: Ultrasound clinicUD: Urodynamics clinicOHC: Out-patient hysteroscopy or procedure clinicR: ResearchMT: Registrar / medical student teachingOCG: On-call gynaeOCO: On-call obstetWR: Ward roundU: Unallocated / freeMeetings, Presentations, Publications and ResearchMeetings attended related to Gynaecological EndoscopyDateVenueMeeting Name PublicationsDate PublishedAuthorsTitle PresentationsDate PresentedMeeting NameTitle Research projects undertaken in this timeResearch TitleSupervisorResearch MethodCurrent StatusSummary of research to current time Clinical and Management SkillsGynaecological 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 TARsAssisted 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 SummaryLaparoscopic ProceduresPeritoneal SurgeryMinimal/mild endometriosis (stage I/II) - Perform min. of 20 unassistedPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingModerate/ Severe endometriosis (Stage III/IV, including endometrioma) - Perform min. of 10 unassistedPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingAdvanced adhesiolysis (this is defined as adhesions requiring >45min to lyse) - Perform min. of 10 unassistedPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingOvarian SurgeryOvarian cystectomy, oophorecetomy or salpingo-oophorectomy - Perform min. of 10 unassistedPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingOvarian Cysts - Perform min. of 10 unassistedPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingOvarian transposition - Perform under direct supervisionPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingTubal SurgerySalpingostomy and/or Salpingectomy for ectopic pregnancy - Perform min. of 10 unassistedPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingSalpingectomy for sterilisation and/or for tubal pathology - Perform min. of 10 unassistedPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingTubal reanastomosis - UnderstandPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingNeosalpingostomy and salpingoplasty - UnderstandPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingOther tubal surgeryPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingUterine SurgeryLaparoscopic hysterectomy - Perform min. of 20 unassistedPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingLaparoscopic myomectomy - Perform min. of 10 unassistedPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingOther uterine surgeryPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingVaginal and Urogynaecological SurgeryLaparoscopic procedure for prolapse - Perform under direct supervisionPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingLaparoscopic procedure for incontinence - Perform under direct supervisionPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingVaginal procedure for prolapse - Perform under direct supervisionPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingVaginal procedure for incontinence - Perform under direct supervisionPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingVaginal hysterectomy - Perform under direct supervisionPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingAbdominal ProceduresAbdominal hysterectomyPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingPost partum hysterectomyPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingAbdominal myomectomyPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingOther abdominal surgeryPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingHysteroscopic ProceduresOutpatient hysteroscopy - Perform under direct supervisionPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingHysteroscopic treatment of myoma - Perform min. of 10 unassistedPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingHysteroscopic treatment of polyp - Perform min. of 10 unassistedPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingHysteroscopic septoplasty and hysteroscopic adhesiolysis - Perform min. of 10 unassistedPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingRobotic ProceduresRobotic Proecdures - UnderstandUnderstand (not perform)Direct SupervisionPerform UnassistedUrological ProceduresDiagnostic cystoscopy - Perform min. of 10 unassistedPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingUreteric catheterization (using straight catheters that are not left in the ureters for a prolonged time) - Perform min. of 10 unassistedPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingUreteric stenting (using double J stents that are placed for a prolonged time and require removal) - UnderstandUnderstand (not perform)Direct SupervisionPerform UnassistedUreteric reanastomosis - UnderstandUnderstand (not perform)Direct SupervisionPerform UnassistedColorectal ProceduresSigmoidoscopy - UnderstandUnderstand (not perform)Direct SupervisionPerform UnassistedSimple primary bowel repair after removal of small volume disease or immediate sharp injury - Perform under direct supervisionPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingSmall bowel resection - UnderstandUnderstand (not perform)Direct SupervisionPerform UnassistedDisc excision of rectosigmoidPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingColostopy / ileostomy creation / closurePrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingLeft hemicolectomy/bowel resection for gynaecological disease (e.g. endometriosis)Primary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingAnterior resection of rectosigmoidPrimary Surgeon AssistedPrimary Surgeon UnassistedTaught to Junior StaffAssisted at this ProcedureTotal exposure to this procedure over training semesterTotal exposure to this procedure during AGES trainingThis 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 Confirmation Email* You will receive an automated confirmation email once this form has been submitted. 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