Unit Re-accreditation Application Form AGES is proud to be at the forefront of training in advanced endoscopic training on a global perspective and encourages all units to continue as an AGES Accredited Training Site. Application for AATP Unit Re-accreditationThis form is to be completed by the training unit's Training Unit Director who oversees training within the unit.Name of Accredited Training Unit*Number of trainees currently:Please enter a number from 1 to 2.Accredited Training Unit Director TitleMr.Mrs.Miss.Ms.Dr.Prof.A/Prof.Rev. Prefix First Last Address Street Address City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country PhoneMobileEmail* Date DD slash MM slash YYYY Training SitesTraining Site 1Address Street Address City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country PhoneWebsite Training Site 2Address Street Address City State Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country PhoneWebsite Training Site 3Address Street Address City State Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country PhoneWebsite Training Site 4Address Street Address City State Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country PhoneWebsite 1. Workload1.1 Clinical ServicesPlease list and quantify the clinical services provided in the training unit in the last 12 months, with details of trainee participation. Please note that trainees are not expected to perform each of the procedures independently.LAPAROSCOPIC PROCEDURESPeritoneal SurgeryMinimal / Mild Endometriosis (Stage I / II)Procedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeModerate / Severe Endometriosis (Stage III / IV, inc. Endometrioma)Procedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeAdvanced Adhesiolysis (defined as Adhesions requiring >45mins to lyse)Procedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeOvarian SurgeryEndometrioma / Ovarian CystectomyProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeOophorectomy or Salpingo-oophorectomyProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeOvarian TranspositionProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeTubal SurgerySalpingostomy and/or Salpingectomy for Ectopic PregnancyProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeSalpingectomy for Sterilisation and / or Tubal PathologyProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeTubal ReanastomosisProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeNeosalpingostomy and SalpingoplastyProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeUterine SurgeryLaparoscopic HysterectomyProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeLaparoscopic MyomectomyProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeUterine ProlapseLaparoscopic Procedure for ProlapseProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeLaparoscopic Procedure for IncontinenceProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeVaginal Procedure for ProlapseProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeVaginal Procedure for IncontinenceProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeVaginal HysterectomyProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeABDOMINAL PROCEDURESAbdominal HysterectomyProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeAbdominal MyomectomyProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeOther Abdominal Surgery (Oophorectomy)Procedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeHYSTEROSCOPIC PROCEDURESOutpatient HysteroscopyProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeHysteroscopic Treatment of MyomaProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeHysteroscopic Treatment of PolypProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeHysteroscopic Septoplasty and / or Hysteroscopic AdhesiolysisProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeROBOTIC PROCEDURESRobotic ProceduresProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeUROLOGICAL PROCEDURESDiagnostic CystoscopyProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeUretic Catheterization - using straight catheters that are not left in the ureters for a procedureProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeUretic Stenting - using Double J stents that are placed for a prolonged time and require removalProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeUretic ReanastomosisProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeCOLORECTAL PROCEDURESSigmoidoscopyProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeDisc Excision of RectosigmoidProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeAnterior Resection Of RectosigmoidProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeLeft Hemicolectomy / Bowel Resection for Gynaecological DiseaseProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeColostopy or Ileostomy Creation / ClosureProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeSmall Bowel ResectionProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeSimple Primary Bowel Repair After Removal of Small Volume Disease or Immediate Sharp InjuryProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by traineeOTHERProcedureProcedures performed / patients provided with this serviceProcedures in which trainee will act as first assistantProcedures performed by trainee Have you had any concerns about trainee access to specific procedures required for the AATP during the last 5 years? If so, what has changed to enable trainee access during the next 5 years?2. Staff2.1 Specialists to be AGES Accredited SupervisorsA minimum of two (2) AGES Accredited Supervisors required for each training position. This includes the Director of the Training Unit. Must be gynaecological endoscopists and must meet the criteria of the Training Supervisor's Agreement. If more than one site is part of the Training Unit, there must be a Training Supervisor at each site, with one having overall responsibility for each trainee.AGES Accredited Supervisor 1Name* TitleMr.Mrs.MissMs.Dr.Prof.A/Prof.Rev. Prefix First Last List*MobileEmailQualificationsPosition*SiteProportion of time spent at this siteResponsibility for RANZCOG trainees in the past 5 yearsAGES Accredited Supervisor 2Name TitleMr.Mrs.MissMs.Dr.Prof.A/Prof.Rev. Prefix First Last ListMobileEmailQualificationsPositionSiteProportion of time spent at this siteResponsibility for RANZCOG trainees in the past 5 yearsAGES Accredited Supervisor 3Name TitleMr.Mrs.MissMs.Dr.Prof.A/Prof.Rev. Prefix First Last ListMobileEmailQualificationsPositionSiteProportion of time spent at this siteResponsibility for RANZCOG trainees in the past 5 yearsAGES Accredited Supervisor 4Name TitleMr.Mrs.MissMs.Dr.Prof.A/Prof.Rev. Prefix First Last ListMobileEmailQualificationsPositionSiteProportion of time spent at this siteResponsibility for RANZCOG trainees in the past 5 years2.2 Other SpecialistsPlease detail the other practitioners working at a specialty level in the Training Unit.Other SupervisorsTitleNameMobileEmailQualificationsPositionSiteProportion of time spent at this siteResponsibility for RANZCOG trainees in the past 5 years 2.3 Allied/Other Health ProfessionalsPlease provide examples of liaison/collaboration with other health professionals. eg physiotherapists, counselors, physicians, general surgeons, urologists, colorectal surgeons, etc.Allied/Other Health ProfessionalsNameArea of Health ExpertiseExamples of liaison/interface/collaboration 3. Facilities3.1 Services & associated equipmentList the diagnostic services that the trainee may access.Reproductive histopathologyDescriptionPractice Location Organ imaging facilities, including ultrasound, interventional radiology, CT and MRIDescriptionPractice Location Ethical and AdministrativeDescriptionPractice Location 3.2 Comprehensive care provisionDuring the past 5 years, have any concerns been raised about the comprehensive care provision to patients with gynaecological conditions associated with this Training Unit?Consultative and nonsurgical careSurgeryDoes the Training Unit provide trainees with learning opportunities associated with access to other surgical specialties, sub-specialties, critical care, community education and liaison?Critical CareAccess to other surgical specialities and subspecialtiesCommunity education and liaison3.3 Library & Information Technology facilitiesDescribe the facilities available to the trainee/s at your Training Unit. This includes 24-hour access to computers and a range of library and other digital resources - medical databases, journals, software, etc.3.4 Research facilitiesDescribe the facilities and resource personnel available within the Training Unit to support specialty research.4. Activities4.1 Meetingsa) Specialty meetingsName of MeetingDescriptionMeeting Schedule Provide a timetable of regular education, peer review, practice review, and clinical management meetings at a specialty level.b) RepresentationName of SpecialistRepresentative Describe the representation of specialists in the unit at hospital and local clinical, multidisciplinary and scientific meetings.4.2 Teaching and EducationOutline the Training Unit's involvement in teaching students and other health professionals. Provide examples of the opportunities for trainees to participate in this teaching.Description4.3 Trainee timetableFor each site present a typical weekly timetable for each trainee.SiteWeekly TimetableMondayTuesdayWednesdayThursdayFriday SiteWeekly TimetableMondayTuesdayWednesdayThursdayFriday SiteWeekly TimetableMondayTuesdayWednesdayThursdayFriday SiteWeekly TimetableMondayTuesdayWednesdayThursdayFriday 4.4 PublicationsList, or attach below, ten peer-reviewed research publications from your Training Unit in the last 5 years.Upload documentation Drop files here or Select files Max. file size: 64 MB. 4.5 PresentationsList, or attach below, ten presentations from your Training Unit in the last 5 years. Please include title of presentation, presenter name, title of conference / scientific meeting and date of presentation for each.Upload presentation(s) Drop files here or Select files Max. file size: 64 MB. 4.6 Researcha) Current researchList the current research projects in your Training Unit.Title of research projectNames of researchersBrief description of researchExpected completion date b) Research opportunitiesDescribe the research opportunities for prospective trainees in your Training Unit.5. Funding5.1 CurrentTrainees be remunerated no less than other trainees in a comparable training level, as described by the regional health authority. Provide evidence of remuneration from current or recent AATP trainees.Current Trainee SalaryUpload evidence of current remuneration Drop files here or Select files Max. file size: 64 MB. 5.2 FutureProvide evidence of prospective funding for trainees during the next accreditation period. This may include expected trainee salary, training hospital salary, private unit salary, surgical assisting, grants and other sources.Future Trainee SalaryUpload evidence of future remuneration Drop files here or Select files Max. file size: 64 MB. 6. Declaration of InterestTraining Unit Directors must declare any material interest that would influence training at the Unit, such as directorships and commercial sources of funding.7. Prior TraineesFor your Training Unit, please list the names of all current AATP trainees and Graduates during the last five years including their status - current, completed or did not complete. (Please advise reason for non-completion.) Name of TraineeYearsCurrent / Completed / Did not completeComments 8. Last WordWhat three aspects of your Training Unit are you most proud of?What three aspects of your Training Unit would you most like to improve?We welcome feedback on this application form.NameSignatureDate DD slash MM slash YYYY Δ