TAR Director's Summary - Form 3

This form is required to be completed and submitted once every six months by the AGES Unit Director.

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

Trainee*
Prefix First Last
AGES Accredited Training Unit Name*
Supervisors
Semester
Training Start Date*
DD slash MM slash YYYY
Training End Date*
DD slash MM slash YYYY
Instructions:
1. Collate the responses from the training supervisors (Document 2). At least two are required - one of which one must be the Training Director.
2. For each attribute, indicate the number of consultants who give each rating.
3. Complete the section confirming the training period as satisfactory or unsatisfactory.
4. Ensure that the report is discussed with the trainee and that the trainee has signed the report.
For the following table please summarise by placing a number in the box that reflects the number of senior staff assessing the candidate for that domain.
Professionalism
Effectiveness and Compassion in dealing with patients and relatives
Occasional major lapse or frequent minor lapses Few, or occasional lapses No significant lapses Above average, confident An example to others
Effectiveness and cooperation in dealing with peers
Occasional major lapse or frequent minor lapses Few, or occasional lapses No significant lapses Above average, confident An example to others
Effectiveness and Leadership in dealing with subordinates
Occasional major lapse or frequent minor lapses Few, or occasional lapses No significant lapses Above average, confident An example to others
General Achievement
Responsibility and initiative in clinical care, especially quality management and outcomes review
Passive Occasionally initiates Initiating without prompting Coordinates departmental activities Leads departmental activities
Responsibility and initiative in teaching
Passive Occasionally initiates Initiating without prompting Coordinates departmental activities Leads departmental activities
Responsibility and initiative in research
Passive Occasionally initiates Initiating without prompting Coordinates departmental activities Leads departmental activities
Specific Specialty Achievement

Gynaecological surgery - laparoscopy

Rudimentary surgical skills, below expected level at this time	Generally sound skillset, with need of improvement to be independent	Sound surgical skills that inspire confidence of independence	Good surgical skills that inspire confidence to teach this field of surgery	Authoritative skillset that inspires progression to mastery

Gynaecological surgery - hysteroscopy

Rudimentary surgical skills, below expected level at this time	Generally sound skillset, with need of improvement to be independent	Sound surgical skills that inspire confidence of independence	Good surgical skills that inspire confidence to teach this field of surgery	Authoritative skillset that inspires progression to mastery

Gynaecological surgery – vaginal

Insufficient exposure to comment on this type of surgery	Rudimentary surgical skills, below expected level at this time	Generally sound skillset, with need of improvement to be independent	Sound surgical skills that inspire confidence of independence	Good surgical skills that inspire confidence to teach this field of surgery	Authoritative skillset that inspires progression to mastery

Gynaecological surgery – open abdominal

Insufficient exposure to comment on this type of surgery	Rudimentary surgical skills, below expected level at this time	Generally sound skillset, with need of improvement to be independent	Sound surgical skills that inspire confidence of independence	Good surgical skills that inspire confidence to teach this field of surgery	Authoritative skillset that inspires progression to mastery

Non-Gynaecological surgery

Insufficient exposure to comment on this type of surgery	Rudimentary surgical skills, below expected level at this time	Generally sound skillset, with need of improvement to be independent	Sound surgical skills that inspire confidence of independence	Good surgical skills that inspire confidence to teach this field of surgery	Authoritative skillset that inspires progression to mastery

Specific Specialty Achievement
Please note: These domains record absolute levels achieved and are not to be relative to the stage of training.
Female pelvic surgery (open or vaginal)
Rudimentary, still Needs improvement Meets speciality objectives Exceeds speciality objectives Authoritative
Female reproductive surgery (hysteroscopic)
Rudimentary, still Needs improvement Meets speciality objectives Exceeds speciality objectives Authoritative
Female reproductive surgery (laparoscopic)
Rudimentary, still Needs improvement Meets speciality objectives Exceeds speciality objectives Authoritative
Summary
Strengths of Trainee
Weakness of Trainee
Recommended course of action for next training period
The overall performance of the Trainee for this training is deemed to be
- satisfactory
- unsatisfactory
Training Director
Signature*
Date*
DD slash MM slash YYYY
Name*
Prefix First Last
Confirmation Email*

You will receive an automated confirmation email once this form has been submitted.
Name
This field is for validation purposes and should be left unchanged.

Occasional major lapse or frequent minor lapses	Few, or occasional lapses	No significant lapses	Above average, confident	An example to others

Occasional major lapse or frequent minor lapses	Few, or occasional lapses	No significant lapses	Above average, confident	An example to others

Occasional major lapse or frequent minor lapses	Few, or occasional lapses	No significant lapses	Above average, confident	An example to others

Passive	Occasionally initiates	Initiating without prompting	Coordinates departmental activities	Leads departmental activities

TAR Director's Summary - Form 3

Instructions:

Professionalism

General Achievement

Specific Specialty Achievement

Specific Specialty Achievement

Summary

Training Director