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CMSA

PORTFOLIO OF LEARNING

Fellowship in Anaesthetics – FCA(SA)

of

The College of Anaesthetists of South Africa

Registrar Name: ………………………………………………………………………………….

PORTFOLIO OF LEARNING OF THE COLLEGE OF ANAESTHETISTS – FCA(SA) December 2010


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ACKNOWLEDGEMENTS

This document represents a composite from many sources.

We would like to acknowledge the Australian and New Zealand College of Anaesthetists
(ANZCA) for their kind permission to use aspects of their Learning Portfolio from June
2006.

We also acknowledge Dr WGJ Kloeck for the original document on which the CMSA
Portfolio of Learning is based.

We further acknowledge the Royal College of Anaesthetists for use of their electronic
logbook.

NOTE

From January 2011 only electronic versions of this document will be accepted.

COMPILED BY

Dr Dean Gopalan
Prof Arthur Rantloane
Prof Christina Lundgren

For, and on behalf of, The College of Anaesthetists

PORTFOLIO OF LEARNING OF THE COLLEGE OF ANAESTHETISTS – FCA(SA) December 2010


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PORTFOLIO OF LEARNING

CONTENTS
SECTION 1 Purpose of the PORTFOLIO OF LEARNING

SECTION 2 Trainee Details

SECTION 3 Record of Modules (including Logbook)


MODULE 1: Introduction to Anaesthesia and Pain
MODULE 2: Professional Attributes
MODULE 3: Anaesthesia for Trauma and Orthopaedic Surgery
MODULE 4: Obstetric and Gynaecological Anaesthesia
MODULE 5: Anaesthesia for Cardiothoracic Surgery
MODULE 6: Anaesthesia for Vascular Surgery
MODULE 7: Neuroanaesthesia
MODULE 8: Anaesthesia for General, Urologic and Plastic Surgery
MODULE 9: Anaesthesia for ENT, Eye, Dental, Maxillofacial and Head and Neck
Surgery
MODULE 10: Paediatric Anaesthesia
MODULE 11: Pain Management, Regional Anaesthesia and Sedation
MODULE 12: Critical Care
MODULE 13: Professional Practice

SECTION 4 Relevant Electronic Links

SECTION 5 Attendance at Meetings

SECTION 6 Presentations

SECTION 7 Research and Publications

SECTION 8 Other Activities


Teaching Activities
Professional Activities
Community / Outreach Activities
Critical Incident Record

SECTION 9 Assessments

SECTION 10 Declarations of completion of training periods

PORTFOLIO OF LEARNING OF THE COLLEGE OF ANAESTHETISTS – FCA(SA) December 2010


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SECTION 1 … PURPOSE OF THE PORTFOLIO OF LEARNING
SECTION 1

The objective of the College of Anaesthetists Registrar training programme is to produce


specialist anaesthesiologists with the following attributes to provide safe and quality care to their
patients:
• Medical expert
• Communicator
• Collaborator
• Manager
• Health advocate
• Scholar and teacher
• Professional

To achieve these various objectives a detailed and intensive training programme is necessary for
registrars. Such a programme has to focus on the development of each of these attributes to
produce the appropriate specialist. Maintenance of a detailed Portfolio of Learning assists the
Trainee and Supervisors in meeting these objectives.

INTRODUCTION

What is a Portfolio of Learning?

A personal Portfolio of Learning is a detailed inventory maintained by the Trainee. It is used for
recording and reflecting on processes and key events during the whole registrar training period. As
well as acting as a summary of training, the Learning Portfolio assists in planning learning and will
help you to gain the most from your training.
The Learning Portfolio can:
• Help you to track your progress by recording Modules completed, clinical experience
gained, special cases undertaken, skills learned, and assessments completed.
• Assist you to establish learning plans (and revise them when necessary), time
management schedules, and to develop patterns of reflective learning.
• Serve to remind you of the objectives of training and the attributes of a specialist
anaesthetist which are to be achieved.
• Promote self-directed learning.

The purpose of a Learning Portfolio is to help you and your Supervisors plan and implement
training and develop critical and reflective learning and practice. It is based on the “CRITICAL”
concept (Certified Record of In-service Training Including Continuous Assessment and Learning).

Using the Learning Portfolio

Effective self-directed learning depends on self-planning and self-reflection. The Portfolio of


Learning is designed to support both of these aspects of learning in the following ways.
• It assists you in planning and recording learning.
• It helps you to value your learning experience through review, reflection and assessment
of your training and experiences.
• It provides a starting point for discussion of your training with Supervisors.
• It can be used as a quality assurance tool to help you to continually improve your learning
and performance.
The Learning Portfolio has numerous sections where you can record information about your
training. Each of these needs to be completed.

PORTFOLIO OF LEARNING OF THE COLLEGE OF ANAESTHETISTS – FCA(SA) December 2010


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Additional copies of all forms included in the Portfolio of Learning can be downloaded and printed
from the College website (www.collegemedsa.ac.za). These should be inserted into your Portfolio.

Reviewing the Portfolio of Learning

Reviewing the Portfolio of Learning is an important educational and development process. You
should continually review the contents of your Portfolio of Learning and, at intervals, also review
the Portfolio with your Supervisor of Training, Module Supervisor, and any support person.

Reviewing your Portfolio of Learning will:


• Provide you with feedback so that you can learn from mistakes and build on achievements
• Motivate you and enhance your sense of achievement
• Enable you to remedy deficiencies in acquiring knowledge, clinical skills and attitudes
• Consolidate your learning capability
• Help you apply abstract principles to practical contexts
• Allow you to track your progress of learning
• Help you to assess your achievement
• Provide Supervisors with feedback on the effectiveness of their teaching and deficiencies
in your clinical experiences
• Provide some audit of your learning activity

Who reviews your Portfolio of Learning?

1. The Trainee
The Portfolio is primarily aimed at improving the Learning process for the trainee.
Consequently the primary reviewer of the portfolio remains the Trainee.
2. Supervisors and/or Designated Persons
It is expected that candidates formally meet with their supervisor or designated persons
several times each year. At this meeting, supervisors will review the candidate’s progress
and should use entries in the portfolio as a basis for discussion. This allows a structuring of
the supervision process. By referring to and discussing specific areas of learning and
experiences, the supervisor is able to provide informed feedback and constructive advice
with regard to problems and deficiencies. In this way the portfolio allows a structuring of the
supervision process. Ideally, the portfolio should be made available to the supervisor before
the meeting.
3. Academic Anaesthetic Departments
The portfolio provides a record of the registrars training for departmental purposes. This
allows academic departments to improve the content and delivery of their training
programmes. Further, it provides evidence that various departmental objectives, regulations
and targets are met.
4. Faculty / University
The relevant faculty / university may use the portfolio in a similar way to academic
departments.
5. Colleges of Anaesthetists of the CMSA.
The CMSA requires evidence that learning has taken place as part of a structured
programme. The portfolio is an important piece of evidence for this.

PORTFOLIO OF LEARNING OF THE COLLEGE OF ANAESTHETISTS – FCA(SA) December 2010


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Learning Plans
Everyone has a different learning style and, depending on circumstances, rate of learning. A
personal Learning Plan helps you to complete a learning assignment in a way that is most effective
for you. A Learning Plan organises learning and can help to integrate theory and practice. It can
enhance your motivation to learn and your development as a professional.
A Learning Plan identifies:
• why you need to learn (trainee aims)
• what to learn (learning objectives)
• how to learn it (learning processes)
• the time frame needed (time management)
• how well you have learned (assessment, evaluation, self-appraisal etc)
• how to link with past and future learning (reflection)

In preparing a Learning Plan:


• Use your current practice and learning style as the basis of the plan.
• Know the attributes required and the aims and objectives of the particular Module.
• Plan to use the most suitable learning processes for each topic or matter in the Learning
Objectives — these include making notes from textbooks and journals, tutorials, web or CD
based information, discussions with colleagues, learning in small study groups with other
trainees, and self-tests. Learning in small study groups with other trainees is an effective
learning process.

Prepare a plan of learning processes for each Module in your Learning Portfolio. Keep referring to
your plans and revise them whenever necessary (eg if unforeseen circumstances arise). Record
and file your notes in an orderly manner so that you can easily revise. Make a time management
plan (see below) and try to stick to your time schedule. Evaluate learning by self tests and through
the small study group. Reflection is part of the Learning Plan.
Time management
Every task requires a minimum time period to achieve, and learning a topic or skill is no different.
Know your ability to achieve a particular learning task and plan for the time to spend on it. For
example, estimate a time in months that you will need to learn a section (eg Physiology). Break
down the time into weeks or days required to complete learning specific topics in the section.
Revise your plans (ie reallocate time) whenever necessary. Also consider the time needed for
family and friends, recreation, and your health.
Reflection
Much of the Portfolio of Learning revolves round reflective learning, which is an effective method of
getting the most out of clinical experiences, reading, researching and small group learning.
Reflection enables the learner to revisit the experience or learning process after the event, in order
to extract principles and “bank” them for better future use. Reflective learning uses principles
similar to quality assurance, ie using feedback to improve learning and performance (“closing the
loop”). Key steps are outlined below.
• Record your initial experience (eg aspects of knowledge, skills, learning process,
behaviour, ideas, communication, interactions and feelings). Use your own words and
write as much or as little as appropriate.
• Reflect on the experience (ie return to the experience to analyse it retrospectively).
Express your reflections.
• Re-evaluate — identify new perspectives, change in practice or behaviour, readiness for
application, and commitment to action.
— What was the situation (eg your abilities, available support etc)?
— How could this be improved?
— What have you learned from this?

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— How would you do this differently the next time?

PORTFOLIO OF LEARNING OF THE COLLEGE OF ANAESTHETISTS – FCA(SA) December 2010


Portfolio Completion Criteria

• The Portfolio should always be used in conjunction with the Regulations and Syllabus for
admission to the Fellowship of the College of Anaesthetists of South Africa FCA(SA), as may
be amended from time to time.
• Entries must at all times be legible and, where indicated, supported by the required
signatories (Supervising Consultants and Heads of Departments and their contact details).
Add pages to each Section as necessary. Ensure that your name appears on every page. It is
strongly advised that you keep an electronic backup copy of all entries, as well as a printed
copy.
• Each Rotation will need to be verified by the relevant Head of Department, including the
completed “Record of Procedures Done” and “Clinical Practice Rating and Evaluation” for
each Rotation.
• The portfolio and supporting certificates and documents must reach the Academic Registrar of
the CMSA (together with the relevant assessment fee, if applicable) at least 3 (three) months
prior to the commencement of the FCA(SA) Part II Examination. Failure to submit the portfolio
before this time will result in the candidate not being invited to the examination.
• The Declaration Forms (Section 10) must be correctly completed and signed before submitting
the portfolio to the CMSA. A declaration form for each year is to be signed off by the Head of
Department. The original of such form is to be held by the academic department with a copy
given to the Trainee.
• A Certificate of Completion of Training is to be completed by the Head of Department when the
candidate wishes to register for the FCA(SA) Part II with the CMSA. This Certificate is to
accompany the Candidate’s application form.
• Please ensure that you do not include any confidential patient information in the
Learning Portfolio.

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SECTION
Section 2 2 … TRAINEE DETAILS

SURNAME: .......................................................................................................................................

FIRST NAMES: .................................................................................................................................

ID NUMBER: .....................................................................................................................................

PASSPORT NUMBER: ………………………………………………………………………………………

Append certified copy of either Identity Document or Passport

HPCSA NUMBER: ............................................................................................................................

Append certified copy of current HPCSA Registration

TRAINEE POST NUMBER: ..............................................................................................................

WORK ADDRESS: ...........................................................................................................................

............ ………………………………………………………………………………………………………..

............ ………………………………………………………………………………………………………..

RESIDENTIAL ADDRESS: ...............................................................................................................

............ ………………………………………………………………………………………………………..

............ ………………………………………………………………………………………………………..

PREFERRED POSTAL ADDRESS: .................................................................................................

............. ……………………………………………………………………………………………………….

............. ……………………………………………………………………………………………………….

……………………………………………………..… POSTAL CODE:…………………………………….

EMAIL ADDRESS: ............................................................................................................................

TELEPHONE NUMBER: (Work):………………………………. (Home): ............ ………………………

CELLPHONE NUMBER: ...................................................................................................................

FAX NUMBER: .................................................................................................................................

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UNDERGRADUATE MEDICAL QUALIFICATIONS

UNIVERSITY: ........................................................................ ….. ........ YEAR:……………………….

Append certified copy of Medical Degree Certificate

INTERNSHIP

HOSPITAL: .................................................................................. ...... YEARS:……………………….

START DATE END DATE ROTATION

YY/MM/DD YY/MM/DD

YY/MM/DD YY/MM/DD

YY/MM/DD YY/MM/DD

YY/MM/DD YY/MM/DD

YY/MM/DD YY/MM/DD

YY/MM/DD YY/MM/DD

Comments:
………………………………………………………………………..…………………………………………
………..…………………………………………………………………………………………………………
………………………………………………………………..…………………………………………………
…………………………………………………………………………………………………………………

COMMUNITY SERVICE

HOSPITAL: .................................................................................. ........ YEAR:……………………….

START DATE END DATE ROTATION

Comments:
………………………………………………………………………………………..…………………………
…………………………………..………………………………………………………………………………
…………………………………………………………………………………………..………………………
…………………………………………………………………………………………………………………

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POST-GRADUATE TRAINING EXPERIENCE
(Prior to commencement of Anaesthetic Registrar Time)

STATUS HOSPITAL DEPARTMENT COUNTRY START END DATE


DATE
YY/MM/DD YY/MM/DD

YY/MM/DD YY/MM/DD

YY/MM/DD YY/MM/DD

YY/MM/DD YY/MM/DD

YY/MM/DD YY/MM/DD

YY/MM/DD YY/MM/DD

Comments:
……………………………………………………………………………………………………………..……
………………………………..…………………………………………………………………………………
………………………………………………………………………………………..…………………………
…………………………………………………………………………………………………………………

COMPLETION OF RELEVANT ANAESTHETIC QUALIFICATIONS


(Include all attempts at each examination)
(Append certified copy of Certificates)

DATE EXAMINATION EXAM RESULT COMMENTS / REMEDIAL ACTION


AUTHORITY
YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

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OTHER POST-GRADUATE QUALIFICATIONS
(Append certified copy of Certificates)

DATE EXAMINATION EXAM RESULT COMMENTS / REMEDIAL ACTION


AUTHORITY
YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

MEMBERSHIP OF ORGANISATIONS
(Include CURRENT membership of associations, societies, professional bodies etc)

ORGANISATION MEMBERSHIP GOOD STANDING


NUMBER

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PRIZES, AWARDS, ACCOLADES RECEIVED

DATE PRIZE / AWARD / ACCOLADE REASON AWARDED AWARDING AUTHORITY

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

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SECTION
Section 3 3 … RECORD OF MODULES

This section covers all the modules the Trainee needs to complete during the period of Registrar
Training.

Note: There will be local institutional / university variations in these. The following modules are
recommended:

MODULE 1: Introduction to Anaesthesia and Pain

MODULE 2: Professional Attributes

MODULE 3: Anaesthesia for Trauma and Orthopaedic Surgery

MODULE 4: Obstetric and Gynaecological Anaesthesia

MODULE 5: Anaesthesia for Cardiothoracic Surgery

MODULE 6: Anaesthesia for Vascular Surgery

MODULE 7: Neuroanaesthesia

MODULE 8: Anaesthesia for General, Urologic and Plastic Surgery

MODULE 9: Anaesthesia for ENT, Eye, Dental, Maxillofacial and Head and Neck
Surgery

MODULE 10: Paediatric Anaesthesia

MODULE 11: Pain Management, Regional Anaesthesia and Sedation

MODULE 12: Critical Care

MODULE 13: Professional Practice

Note: It may not always be possible to complete the module as a continuous rotation. Modules 2 &
13 may be completed throughout the 48 month training period.

The trainee needs to keep a logbook of all cases/procedures done. We recommend the use of the
electronic Royal College logbook. Periodic (eg monthly or after every module) summaries of the
logbook should be extracted and kept electronically.

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CONSOLIDATED RECORD OF COMPLETION OF MODULES / ROTATIONS

The modules below are merely a RECOMMENDATION and will vary at an institutional
level. Where modules have been continuous enter start and end dates of registrar time as
module start and end dates.

MODULE NAME START END DATE SUPERVISOR


DATE SIGNATURE

Introduction to Anaesthesia and


Pain YY/MM/DD YY/MM/DD

Anaesthesia for Trauma and


Orthopaedic Surgery YY/MM/DD YY/MM/DD

Obstetric and Gynaecological


Anaesthesia YY/MM/DD YY/MM/DD

Anaesthesia for Cardiothoracic


Surgery YY/MM/DD YY/MM/DD

Anaesthesia for Vascular Surgery


YY/MM/DD YY/MM/DD

Neuroanaesthesia YY/MM/DD YY/MM/DD

Anaesthesia for General,


Urologic and Plastic Surgery YY/MM/DD YY/MM/DD

Anaesthesia for ENT, Eye,


Dental, Maxillofacial and Head YY/MM/DD YY/MM/DD
and Neck Surgery

Paediatric Anaesthesia YY/MM/DD YY/MM/DD

Pain Management, Regional


Anaesthesia and Sedation YY/MM/DD YY/MM/DD

Critical Care YY/MM/DD YY/MM/DD

Professional Practice YY/MM/DD YY/MM/DD

Professional Attributes YY/MM/DD YY/MM/DD

Other YY/MM/DD YY/MM/DD

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NON-CLINICAL MODULES

Two Non-Clinical Modules are being encouraged as part of the holistic development of registrars.
These are the modules on PROFESSIONAL ATTRIBUTES AND PROFESSIONAL PRACTICE.

Below are guidelines in respect of these modules.

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MODULE: Professional Attributes

Trainee’s Aims
This Module considers the scope of non-clinical professional issues. It covers the understanding of humanistic
issues in professional practice and complements Module 13 Professional Practice.

The overall aim of Module 2 is for Trainees to reflect on and develop the attributes of a medical professional and
a specialist anaesthetist. These are outlined below.

Medical Expert
• Achieves excellence in clinical practice
• Analyses, integrates and adheres to ethical care in clinical practice
• Maintains vigilance
• Recognises that patient safety is paramount

Communicator
• Establishes effective relationships with patients, families, colleagues and other healthcare
workers
• Resolves issues using sound ethical reasoning

Collaborator
• Demonstrates exemplary practice as a member of a multidisciplinary team, by exercising flexible
leadership, consultation and appropriate delegation
• Shows respect for the expertise and concerns of other team members

Manager
• Manages patient care, departmental and personal issues effectively with patience, calm, good
humour and insight
• Allocates and uses health care resources wisely
• Respects the views of others

Health Advocate
• Maintains personal health and well-being
• Promotes health maintenance and occupational safety of patients, self and colleagues

Scholar and Teacher


• Values advances in scientific knowledge; identifies and appraises them critically for incorporation
into contemporary anaesthesia practice
• Enriches knowledge with wisdom
• Maintains life-long learning
• Acknowledges and learns from errors; values appraisal of performance
• Contributes to the education and training of students, postgraduate Trainees and other health
professionals

Professional
• Recognises that patient confidentiality is essential
• Complies with the relevant policies, recommendations, and guidelines in professional practice
• Exhibits appropriate personal and interpersonal professional behaviours
• Values human diversity
• Delivers high quality patient care in a way that is consistent with ethical and medicolegal
obligations of a medical specialist
• Conducts practice with integrity, honesty and compassion
• Accepts peer determinations of clinical competence and professional capabilities
• Recognises and deals with personal and professional limitations

PORTFOLIO OF LEARNING OF THE COLLEGE OF ANAESTHETISTS – FCA(SA) December 2010


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MODULE: Professional Practice

This Module is to be undertaken during Advanced Training, in the course of normal clinical duties and
concurrently with clinical Modules.

Trainee’s Aims

The aim of this module is for Trainees to understand relevant non-clinical management issues. These range from
understanding the culture of the healthcare industry and the anaesthesia profession, to considering one's career
development, combining learning, teaching, administration, professional activities with patient care, and integrating
professional and personal lives.

Learning Objectives

This Module builds on work done in the Module on Professional Attributes and considers knowledge and
skills in six components:

• Health infrastructures
• Administration and management
• Quality assurance
• Ethical, legal and indemnity issues
• Skills in professional practice
• Career and life planning

In this module, the Trainee will demonstrate:


• Knowledge of the relevant South African healthcare national and local (State level) infrastructure
• Capacity to work within the framework of anaesthesia departments through a comprehension of their
structure and their processes
• Capacity to organise one’s work and learning
• Capacity to organise local scientific meetings and research projects
• Comprehension of the legal obligations of professional practice in South Africa
• Understanding of ethical practice
• Communication skills in professional practice
• Commitment to lifelong quality assurance
• Understanding of a realistic life career plan

PORTFOLIO OF LEARNING OF THE COLLEGE OF ANAESTHETISTS – FCA(SA) December 2010


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SECTION 4 … RELEVANT ELECTRONIC LINKS

The Trainee is referred to the following useful electronic resources:

1. College of Anaesthetists of South Africa


Regulations and syllabus
http://www.colegemedsa.ac.za

2. South African Society of Anaesthesiologists (SASA)


Practice Guidelines
http:// www.sasaweb.com

3. Royal College of Anaesthetists (RCoA)


http://www.rcoa.ac.uk/index.asp?SectionID=3
Logbook
http://www.logbook.org.uk/

4. Health Professions Council of South Africa (HPCSA)


http://www.hpcsa.co.za
Registration
http://www.hpcsa.co.za/registration_criteria.php
Health Acts
http://www.hpcsa.co.za/downloads/health_act/health_act_56_1974.doc
Ethical rules
http://www.hpcsa.co.za/conduct_rules.php
Fitness to Practice
http://www.hpcsa.co.za/fitness_practice.php

5. Australian and New Zealand College of Anaesthetists (ANZCA)


http://www.anzca.edu.au
Training Programme
http://www.anzca.edu.au/trainees/atp

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SECTION 5 … ATTENDANCE AT MEETINGS

ROUTINE DEPARTMENTAL ACADEMIC MEETINGS AND TUTORIALS


Record a summary of ROUTINE ACADEMIC departmental meetings in the table below.
Include Morbidity and Mortality type meetings here.
(Attach Certificates of Attendance if applicable)

YEAR DAY FREQUENCY TIME DURATION MEETING/ACTIVITY COMMENTS

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OTHER MEETINGS ATTENDED
Record attendance at Post-graduate Meetings, Lectures, Workshops, Refresher Courses, Modules, Seminars, Symposia or Congresses
relevant to Anaesthesia. (Attach Certificates of Attendance if applicable)

DATE MEETING/ TOPIC PRESENTER VENUE COMMENTS


ACTIVITY
YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

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PORTFOLIO OF LEARNING OF THE COLLEGE OF ANAESTHETISTS – FCA(SA) December 2010


SECTION
SECTION66… PRESENTATIONS
Presentations

List all the presentations you have made in the table below. Include lectures, tutorials delivered, papers presented, journal club
presentations, clinical case presentations.

Where applicable, append letters of invitation to speak.


Attach copies of presentations (Power Point or abstract) made.

DATE EVENT TYPE VENUE TOPIC / SUBJECT / DETAILS DURATION COMMENTS

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

YY/MM/DD

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SECTION 7 … RESEARCH AND PUBLICATIONS

RESEARCH INVOLVEMENT BY CANDIDATE

Note: The fields below are institution specific and need not be completed if not required by your
institution.

GOOD CLINICAL PRACTICE (GCP) CERTIFICATION

Completed Y N

Date Completed YYYY / MM / DD

Certification Authority

(Append GCP Certificate)

RESEARCH METHODOLOGY COURSE

Completed Y N

Date Completed YYYY / MM / DD

Course conducted by

(Append Attendance Certificate)

OTHER RESEARCH RELATED COURSES ATTENDED

Include other courses attended (eg statistics courses) here.

DATE COURSE CONDUCTED BY

YY/MM/DD

YY/MM/DD

YY/MM/DD

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THE RESEARCH COMPONENT OF THE MASTERS IN MEDICINE (MMed)
The table below is a guide for ensuring that you are progressing in respect of your research. This
may vary in your institution.
Where possible, append appropriate certificates, letters of approval, etc.

STEPS DATE SUPERVISOR


SIGNATURE
CHOICE OF SUBJECT YY/MM/DD

CHOICE OF RESEARCH TOPIC YY/MM/DD

LITERATURE SEARCH YY/MM/DD

DEVELOPMENT OF RESEARCH HYPOTHESIS YY/MM/DD

COMPLETION OF PROTOCOL YY/MM/DD

PRESENTATION AT RESEARCH MEETING YY/MM/DD

PROTOCOL REVISION YY/MM/DD

STATISTICAL PLANNING YY/MM/DD

PLANNING OF BUDGET YY/MM/DD

TRANSLATION OF CONSENT YY/MM/DD

SUBMISSION TO POST-GRADUATE COMMITTEE YY/MM/DD


(or equivalent)
POST-GRADUATE COMMITTEE (or equivalent) YY/MM/DD
APPROVAL
APPROVAL BY ETHICS COMMITTEE YY/MM/DD

INSTITUTIONAL APPROVAL (as appropriate) YY/MM/DD

OTHER DEPARTMENTS/ROLE PLAYERS INFORMED YY/MM/DD

DATA COLLECTION COMPLETED YY/MM/DD

DATA ENTRY AND PROCESSING YY/MM/DD

MANUSCRIPT / THESIS COMPLETION YY/MM/DD

PUBLICATION YY/MM/DD

DEGREE AWARDED YY/MM/DD

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INVOLVEMENT IN OTHER RESEARCH PROJECTS

DETAILS OF PROJECT INVOLVEMENT DATE PRINCIPAL


INVESTIGATOR
SIGNATURE & NAME

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JOURNAL PUBLICATIONS BY CANDIDATE:
(Attach copy of publication)

NO. AUTHORS FULL TITLE JOURNAL VOL. (NO.) PAGES


(list fully in order)

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SECTION 8 … OTHER ACTIVITIES

TEACHING ACTIVITIES

Record here all formal and informal teaching of medical students, interns, medical officers, other
registrars, nurses, allied health personnel and any other individuals. Record details of the teaching
session and reflective comments if you find them useful in your learning and professional
development.

DATE TEACHING DETAILS REFLECTIVE COMMENTS


ACTIVITY

YY/MM/DD

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DATE TEACHING ACTIVIT DETAILS REFLECTIVE COMMENTS

YY/MM/DD

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PROFESSIONAL ACTIVITIES

Record here all activities in respect of committees in which you are involved, management structures that
you have participated in, and leadership roles that you may have assumed.

DATE STRUCTURE ACTIVITY

YY/MM/DD

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COMMUNITY / OUTREACH ACTIVITIES

Record here all activities that you have participated in as part out outreach or community development.

DATE STRUCTURE ACTIVITY

YY/MM/DD

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CRITICAL INCIDENT MONITORING

Record critical incidents that you experience or are aware of that will help your learning. Include
major and minor incidents that occur. eg drug administration errors, failed/difficult intubation,
complications of regionals, death on the table.

Please ensure that you do not include any confidential patient information or names of individuals
involved.

DATE CRITICAL INCIDENT NOTES ON LESSON LEARNED OR REFLECT

YY/MM/DD

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DATE CRITICAL INCIDENT NOTES ON LESSON LEARNED OR REFLECT

YY/MM/DD

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SECTION 9 … ASSESSMENTS

Record or append all assessments here.


Such assessments to include:

1. Assessment of Trainee by Supervisor / Module Supervisor

2. Assessment of Module / rotation by Trainee

There are institutional variations in these assessments. Include what is used at your training centre.
At a minimum, such In-Training Assessment (ITA) forms should include:
i. Period of assessment
ii. Module/Block/Rotation completed
iii. Supervisor/s of training
iv. Date of assessment
v. Result of assessment (eg exceeds requirements, meets requirements, does
not meet requirements
vi. Evidence of feedback / remedial action if necessary
vii. Name of assessor
viii. Signature of assessor

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SECTION 10 … DECLARATIONS OF COMPLETION OF TRAINING PERIODS

Appropriate declarations of completion of training need to be completed and signed by both the
Trainee and Supervisor. Four such declarations need to be completed, one for each year of training.

In addition, the supervisor needs to complete the required forms when the candidate enrols for the
FCA(SA) Part II of the CMSA.

Copies of the declaration form are to be held by the academic department.

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DECLARATION ON COMPLETION OF TRAINING – YEAR 1

I, …………………………………………………………….hereby do solemnly declare that all

information contained in this PORTFOLIO OF LEARNING is a true and accurate record of

my professional experience, education and training from dd / mm / cccc to dd / mm / cccc

representing the period of training for the Anaesthetic qualification.

Signature of Candidate: ................................................................................................

Name of Candidate: ......................................................................................................

Trainee Number: ...........................................................................................................

Date: .............................................................................................................................

I, …………………………………………………………….hereby declare that I have

inspected the information contained in this PORTFOLIO OF LEARNING in respect of the

Trainee’s professional experience, education and training from dd / mm / cccc to dd / mm /

cccc representing the period of training for the Anaesthetic qualification.

Signature of Academic Head of Department:................................................................

Name of HOD: ..............................................................................................................

Date: .............................................................................................................................

Departmental / University
Stamp

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DECLARATION ON COMPLETION OF TRAINING – YEAR 2

I, …………………………………………………………….hereby do solemnly declare that all

information contained in this PORTFOLIO OF LEARNING is a true and accurate record of

my professional experience, education and training from dd / mm / cccc to dd / mm / cccc

representing the period of training for the Anaesthetic qualification.

Signature of Candidate: ................................................................................................

Name of Candidate: ......................................................................................................

Trainee Number: ...........................................................................................................

Date: .............................................................................................................................

I, …………………………………………………………….hereby declare that I have

inspected the information contained in this PORTFOLIO OF LEARNING in respect of the

Trainee’s professional experience, education and training from dd / mm / cccc to dd / mm /

cccc representing the period of training for the Anaesthetic qualification.

Signature of Academic Head of Department:................................................................

Name of HOD: ..............................................................................................................

Date: .............................................................................................................................

Departmental / University
Stamp

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DECLARATION ON COMPLETION OF TRAINING – YEAR 3

I, …………………………………………………………….hereby do solemnly declare that all

information contained in this PORTFOLIO OF LEARNING is a true and accurate record of

my professional experience, education and training from dd / mm / cccc to dd / mm / cccc

representing the period of training for the Anaesthetic qualification.

Signature of Candidate: ................................................................................................

Name of Candidate: ......................................................................................................

Trainee Number: ...........................................................................................................

Date: .............................................................................................................................

I, …………………………………………………………….hereby declare that I have

inspected the information contained in this PORTFOLIO OF LEARNING in respect of the

Trainee’s professional experience, education and training from dd / mm / cccc to dd / mm

/ cccc representing the period of training for the Anaesthetic qualification.

Signature of Academic Head of Department:................................................................

Name of HOD: ..............................................................................................................

Date: .............................................................................................................................

Departmental / University
Stamp

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DECLARATION ON COMPLETION OF TRAINING – YEAR 4

I, …………………………………………………………….hereby do solemnly declare that all

information contained in this PORTFOLIO OF LEARNING is a true and accurate record of

my professional experience, education and training from dd / mm / cccc to dd / mm / cccc

representing the period of training for the Anaesthetic qualification.

Signature of Candidate: ................................................................................................

Name of Candidate: ......................................................................................................

Trainee Number: ...........................................................................................................

Date: .............................................................................................................................

I, …………………………………………………………….hereby declare that I have

inspected the information contained in this PORTFOLIO OF LEARNING in respect of the

Trainee’s professional experience, education and training from dd / mm / cccc to dd / mm

/ cccc representing the period of training for the Anaesthetic qualification.

Signature of Academic Head of Department:................................................................

Name of HOD: ..............................................................................................................

Date: .............................................................................................................................

Departmental / University
Stamp

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DECLARATION BY ACADEMIC HEAD FOR TRAINEE TO ENROL IN
EXAMINATION

I hereby declare that I have inspected the information contained in this PORTFOLIO OF

LEARNING in respect of the Trainee’s professional experience, education and training

from dd / mm / cccc to dd / mm / cccc representing the period of training for the

Anaesthetic qualification.

I further certify that the Trainee has fulfilled the requirements below:

The trainee has successfully completed/is exempt from the YES NO


FCA(SA) Part I examination
The trainee has completed at least three years following full YES NO
registration by the Health Professions Council of South Africa as
a medical practitioner.
The trainee will have held a fulltime appointment as a registrar in YES NO
the Department of Anaesthetics in a teaching hospital or teaching
hospital satellite department for at least THIRTY-SIX MONTHS at
the time of writing the examination.
The trainee has been assigned for three months of the above YES NO
period to an Intensive Care Unit on a fulltime basis.
The trainee has successfully completed all the Departmental and YES NO
Faculty requirements in respect of training in Anaesthesiology.

Signature of Academic Head of Department:................................................................

Name of HOD: ..............................................................................................................

Date: .............................................................................................................................

Departmental / University
Stamp

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