TAR Supervisor's Report - Form 2 This form is required to be completed and submitted once every six months by each AGES accredited training supervisor. This online form will be automatically submitted to the AGES Secretariat. Trainee* TitleMr.Mrs.MissMs.Dr.Prof.A/Prof.Rev. Prefix First Last AGES Accredited Training Unit Name*Semester*1234Training Start Date* DD slash MM slash YYYY Training End Date* DD slash MM slash YYYY Instructions: Please indicate your assessment of the Trainee in each of the following domains. Please note, the term ‘Stage’ is used to encourage you to consider the absolute level of development the Trainee is at with respect to the domain rather than relative to the Training year. The comparator for training is a trainee in advanced laparoscopic surgery in their first or second year of training and not a FRANZCOG trainee undertaking general training. Please select the options that best describes the Trainee’s present performance in the domain. Training Supervisors are also asked to complete the Trainee strengths and weaknesses section.ProfessionalismEffectiveness and compassion in dealing with patients and relatives Stage 1 - Occasional major lapse or frequent minor lapse Stage 2 - Few, or occasional minor lapses Stage 3 - No significant lapses Stage 4 - Above average, confident Stage 5 - An example to others Effectiveness and cooperation in dealing with peers Stage 1 - Occasional major lapse or frequent minor lapse Stage 2 - Few, or occasional minor lapses Stage 3 - No significant lapses Stage 4 - Above average, confident Stage 5 - An example to others Effectiveness and leadership in dealing with subordinates Stage 1 - Occasional major lapse or frequent minor lapse Stage 2 - Few, or occasional minor lapses Stage 3 - No significant lapses Stage 4 - Above average, confident Stage 5 - An example to others General AchievementResponsibility and initiative in clinical care (including quality assurance activities, oversight of morbidity and quality cycle) Stage 1 - Minimal or no input Stage 2 - Occasionally initiates activities Stage 3 - Initiating without prompting Stage 4 - Coordinates departmental activities Stage 5 - Leads departmental activities Responsibility and initiative to teach specifically in the field of gynaecological surgery Stage 1 - Minimal or no input Stage 2 - Occasionally initiates activities Stage 3 - Initiating without prompting Stage 4 - Coordinates departmental activities Stage 5 - Leads departmental activities Responsibility and initiative to research activities specifically in the field of gynaecological surgery Stage 1 - Minimal or no input Stage 2 - Occasionally initiates activities Stage 3 - Initiating without prompting Stage 4 - Coordinates departmental activities Stage 5 - Leads departmental activities Specific Specialty AchievementGynaecological surgery - laparoscopy Stage 1 - Rudimentary surgical skills, below expected level at this time Stage 2 - Generally sound skillset, with need of improvement to be independent Stage 3 - Sound surgical skills that inspire confidence of independence Stage 4 - Good surgical skills that inspire confidence to teach this field of surgery Stage 5 - Authoritative skillset that inspires progression to mastery Gynaecological surgery - hysteroscopy Stage 1 - Rudimentary surgical skills, below expected level at this time Stage 2 - Generally sound skillset, with need of improvement to be independent Stage 3 - Sound surgical skills that inspire confidence of independence Stage 4 - Good surgical skills that inspire confidence to teach this field of surgery Stage 5 - Authoritative skillset that inspires progression to mastery Gynaecological surgery – vaginal Stage 1 - Insufficient exposure to comment on this type of surgery Stage 2 - Rudimentary surgical skills, below expected level at this time Stage 3 - Generally sound skillset, with need of improvement to be independent Stage 4 - Sound surgical skills that inspire confidence of independence Stage 5 - Good surgical skills that inspire confidence to teach this field of surgery Stage 6 - Authoritative skillset that inspires progression to mastery Gynaecological surgery – open abdominal Stage 1 - Insufficient exposure to comment on this type of surgery Stage 2 - Rudimentary surgical skills, below expected level at this time Stage 3 - Generally sound skillset, with need of improvement to be independent Stage 4 - Sound surgical skills that inspire confidence of independence Stage 5 - Good surgical skills that inspire confidence to teach this field of surgery Stage 6 - Authoritative skillset that inspires progression to mastery Non-Gynaecological surgery Stage 1 - Insufficient exposure to comment on this type of surgery Stage 2 - Rudimentary surgical skills, below expected level at this time Stage 3 - Generally sound skillset, with need of improvement to be independent Stage 4 - Sound surgical skills that inspire confidence of independence Stage 5 - Good surgical skills that inspire confidence to teach this field of surgery Stage 6 - Authoritative skillset that inspires progression to mastery Specific Specialty AchievementPlease note: These domains record absolute levels achieved and are not to be relative to the stage of training. Female pelvic surgery (open or vaginal) Stage 1 - Rudimentary, still Stage 2 - Needs improvement Stage 3 - Meets specialty objectives Stage 4 - Exceeds specialty objectives Stage 5 - Authoritative Female reproductive surgery (hysteroscopic) Stage 1 - Rudimentary, still Stage 2 - Needs improvement Stage 3 - Meets specialty objectives Stage 4 - Exceeds specialty objectives Stage 5 - Authoritative Female reproductive surgery (laparoscopic) Stage 1 - Rudimentary, still Stage 2 - Needs improvement Stage 3 - Meets specialty objectives Stage 4 - Exceeds specialty objectives Stage 5 - Authoritative SummaryStrengths of TraineeWeakness of TraineeRecommended course of action for next training periodThe overall performance of the Trainee for this training is deemed to be: Satisfactory Unsatisfactory Training SupervisorSignature*Name* TitleMr.Mrs.MissMs.Dr.Prof.A/Prof.Rev. Prefix First Last Date* DD slash MM slash YYYY Confirmation Email* You will receive an automated confirmation email once this form has been submitted. NameThis field is for validation purposes and should be left unchanged. Δ
