Application for AGES
Re-accreditation

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 Process

This application must be completed for the re-accreditation of a training unit by the Australasian Gynaecological Endoscopy and Surgery (AGES) Society. This application must also be completed for subsequent re-accreditation or if there is any material change in the conduct of the training program over the accreditation period. All applications must be received by 1st May.

Incomplete applications will be returned with a request to provide the missing information, which may delay processing.

Each accredited training unit will be approved for a period of up to four years. Accreditation will be based on the information presented in this application and site visits by AGES Society assessors as required.

Applicants are advised to complete the application form in accordance with the standards outlined in the document Australasian Gynaecological Endoscopy and Surgery Society Training Program in Gynaecological Endoscopy. This document is sent out with the application form and additional copies are available from the AGES secretariat.

(NB: A training unit may be comprised of more than one hospital and/or training site.)

The following must accompany each application:

Application for Accreditation of a Gynaecological Endoscopy Training Unit
Application Fee
AUD3300 (Inclusive of GST)
Training Fee per Trainee per year (once accredited)
AUD1500 per annum (Inclusive of GST)

Please complete the form below

Application for AGES Re-accreditation
This form is to be completed by the training unit's proposed Training Director who will oversee training within the unit.
Name of Unit*
Number of trainees applied for (max 2):
Please enter a number from 1 to 2.
Training Director
Prefix First Last
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Phone
Mobile
Email*
Date
DD slash MM slash YYYY
Training Sites
Training Site 1
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Phone
Website
Training Site 2
Address
Street Address City State Postal Code Country
Phone
Website
Training Site 3
Address
Street Address City State Postal Code Country
Phone
Website
Training Site 4
Address
Street Address City State Postal Code Country
Phone
Website
1. Workload
1.1 Clinical Services
Please list and quantify the clinical services provided in the training unit in the last 12 months, with details of trainee participation. In the case of new units, please estimate expected trainee participation. Please note that trainees are not expected to perform each of the procedures independently.
LAPAROSCOPIC PROCEDURES
Peritoneal Surgery
Minimal / mild endometriosis
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Severe endometriosis
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Advanced adhesiolysis
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Ovarian Surgery
Ovarian cysts
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Ovarian transposition
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Tubal Surgery
Ectopic pregnancy
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Salpingectomy for tubal pathology
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Reanastomosis
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Neoalpingostomy and salpingoplasty
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Uterine Surgery
Laparoscopic hysterectomy
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Laparoscopic myomectomy
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Uterine Prolapse
Bladder neck suspension procedures
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Uterine suspension procedures
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Pelvic organ prolapse procedures
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
HYSTEROSCOPIC PROCEDURES
Outpatient hysteroscopy
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Resection of fibroid
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Resection of polyp / Division of septum
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Division of adhesions
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
ROBOTIC PROCEDURES
Robotic Procedures
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
UROLOGICAL PROCEDURES
Diagnostic cystoscopy
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Ureteric catheterization
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Ureteric stenting
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Ureteric reanastomosis
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
COLORECTAL PROCEDURES
Anterior Resection
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Hemicolectomy (left)
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Ileostomy and reveral
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Sigmoidoscopy
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Small bowel resection
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
Bowel repair
Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
OTHER
Procedure Procedures performed / patients provided with this service Procedures in which trainee will act as first assistant Procedures performed by trainee
2. Staff
2.1 Specialists to be AGES Accredited Supervisors
A 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 1
Name*
Prefix First Last
List*
Mobile Email Qualifications Position
*
Site Proportion of time spent at this site Responsibility for RANZCOG tranees in the past 5 years
AGES Accredited Supervisor 2
Name
Prefix First Last
List
Mobile Email Qualifications Position
Site Proportion of time spent at this site Responsibility for RANZCOG tranees in the past 5 years
AGES Accredited Supervisor 3
Name
Prefix First Last
List
Mobile Email Qualifications Position
Site Proportion of time spent at this site Responsibility for RANZCOG tranees in the past 5 years
AGES Accredited Supervisor 4
Name
Prefix First Last
List
Mobile Email Qualifications Position
Site Proportion of time spent at this site Responsibility for RANZCOG tranees in the past 5 years
2.2 Other Specialists
Please detail the other practitioners working at a specialty level in the Training Unit.
Other Supervisors
Title Name Mobile Email Qualifications Position Site Proportion of time spent at this site Responsibility for RANZCOG tranees in the past 5 years
2.3 Allied/Other Health Professionals
Please provide details of liaison/collaboration with other health professionals. eg physiotherapists, counselors, physicians, general surgeons, urologists, colorectal surgeons, etc.
Allied/Other Health Professionals
Name Area of Health Expertise Details of liaison/interface/collaboration
3. Facilities
3.1 Services & associated equipment
List the diagnostic services that the trainee may access.
Reproductive histopathology
Description Practice Location
Organ imaging facilities, including ultrasound, interventional radiology, CT and MRI
Description Practice Location
Ethical and Administrative
Description Practice Location
3.2 Comprehensive care provision
Describe the comprehensive care provided to patients with gynaecological conditions at the training site.
Consultative and nonsurgical care
Surgery
Critical Care
Access to other surgical specialities and subspecialties
Community education and liaison
3.3 Library & Information Technology facilities
Describe the library facilities within the training unit. Library collections should be extensive, up-to-date and have access to an efficient inter-library loan facility. Please describe after-hours access to library facilities.
Describe the information technolgoy facilities within the training unit. Trainees should have ready access to computers, including online access to a university library and / or medical databases. Please describe after-hours access to information technology facilities.
3.4 Research facilities
Describe the facilities and resource personnel available within the unit to support specialty research.
4. Activities
4.1 Meetings
a) Specialty meetings
Name of Meeting Description Meeting Schedule

Provide a timetable of regular education, peer review, practice review, and clinical management meetings at a specialty level.
b) Representation
Name of Specialist Representative

Describe the representation of specialists in the unit at hospital and local clinical, multidisciplinary and scientific meetings.
4.2 Teaching and Education
Describe the unit's involvement in the teaching and education of:
Nurses
Description
Trainee Involved?
- Yes
- No
Undergraduate: Medical Students
Description
Trainee Involved?
- Yes
- No
Post graduate: Medical Practitioners (residents, registrars and specialists)
Description
Trainee Involved?
- Yes
- No
4.3 Trainee timetable
For each site present a typical weekly timetable for each trainee.
Site
Weekly Timetable
Monday Tuesday Wednesday Thursday Friday
Site
Weekly Timetable
Monday Tuesday Wednesday Thursday Friday
Site
Weekly Timetable
Monday Tuesday Wednesday Thursday Friday
Site
Weekly Timetable
Monday Tuesday Wednesday Thursday Friday
4.4 Publications
List, or attach as an appendix, the publications, published or in preparation, in the last 5 years by specialists in the unit.
Upload documentation
Drop files here or

Max. file size: 64 MB.
4.5 Presentations
List or attach as an appendix, the presentations made by specialists at scientific meetings in the last 5 years.
Title of presentation Name(s) of presenter(s) Title of conference/scientific meeting Date of presentation
Upload presentation(s)
Drop files here or

Max. file size: 64 MB.
4.6 Research
a) Current research
List the current research projects in progress by practitioners working in the unit.
Title of research project Names of researchers Brief description of research Expected completion date
b) Research opportunities
Describe the opportunities for research for prospective trainees and how trainees will be encouraged to participate in clinical research during the course of their training.
5. Funding
Every training unit must demonstrate evidence of prospective funding. It is expected that trainees be remunerated no less than other trainees in a comparable training level, as described by the regional health authority.
Expected Trainee Salary
Training hospital salary
Amount Time period Funding confirmed
Private unit salary
Amount Time period Funding confirmed
Surgical assisting
Amount Time period Funding confirmed
Grants
Amount Time period Funding confirmed
Other
Amount Time period Funding confirmed
6. Declaration of Interest
Program Directors must declare any material interest that would influence training at the unit, such as directorships and commercial sources of funding.
7. Prior Trainees
Please list the trainees that have been accepted into your training program. (Please advise the reason for non-completion if applicable)
Please list the trainees that have been accepted into your training program. (Please advise the reason for non-completion if applicable)
Name of Trainee Years Current / Completed / Did not complete Comments
Name
Signature
Date
DD slash MM slash YYYY

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Procedure	Procedures performed / patients provided with this service	Procedures in which trainee will act as first assistant	Procedures performed by trainee

Title	Name	Mobile	Email	Qualifications	Position	Site	Proportion of time spent at this site	Responsibility for RANZCOG tranees in the past 5 years

Name	Area of Health Expertise	Details of liaison/interface/collaboration

Application for AGES Re-accreditation

Application Process

Application for AGES Re-accreditation

Training Sites

1. Workload

1.1 Clinical Services

LAPAROSCOPIC PROCEDURES

Peritoneal Surgery

Ovarian Surgery

Tubal Surgery

Uterine Surgery

Uterine Prolapse

HYSTEROSCOPIC PROCEDURES

ROBOTIC PROCEDURES

UROLOGICAL PROCEDURES

COLORECTAL PROCEDURES

OTHER

2. Staff

2.1 Specialists to be AGES Accredited Supervisors

AGES Accredited Supervisor 1

AGES Accredited Supervisor 2

AGES Accredited Supervisor 3

AGES Accredited Supervisor 4

2.2 Other Specialists

2.3 Allied/Other Health Professionals

3. Facilities

3.1 Services & associated equipment

3.2 Comprehensive care provision

3.3 Library & Information Technology facilities

3.4 Research facilities

4. Activities

4.1 Meetings

4.2 Teaching and Education

Nurses

Undergraduate: Medical Students

Post graduate: Medical Practitioners (residents, registrars and specialists)

4.3 Trainee timetable

4.4 Publications

4.5 Presentations

4.6 Research

5. Funding

6. Declaration of Interest

7. Prior Trainees

Application for AGES
Re-accreditation