MINISTRY OF HEALTH, MALAYSIA

1. 2.

GAZETTEMENT EVALUATION FORM GAZETTEMENT LOG BOOKS : I. II. IV. V. VI. ANAESTHESIOLOGY INTERNAL MEDICINE PAEDIATRIC ORTHOPAEDIC OTORHINOLARYNGOLOGY (ENT)

III. OBSTETRIC & GYNAECOLOGY

VII. OPHTHALMOLOGY VIII. PSYCHIATRY IX. X. RADIOLOGY SURGERY

JULAI 2005

GAZETTEMENT EVALUATION FORM

1. 2. 3. 4. 5.

Name: ... I.C. No: ....................... Post Graduate Qualification: . Date Of Post Graduate Qualification: Date of Commencement of Pre-gazettement: . (Date Of Reporting To Department) Date of Expected Completion: . Days Of Leave Taken:

6. 7.

SUPERVISORS PARTICULARS
1. 2. Name: .. Designation & Grade:

For Office Use Only Duration of Extension (if Any) : .... Date of Actual Completion :

INTRODUCTION OF GAZETTEMENT
1. Objective Of Gazettement 1.1 General Objective To assess the competency of medical officers to assume responsibility of an independent specialist on completion of specialist training 1.2 Specific Objective 1. To assess clinical skills in diagnosis and management of patients with common disorders in the specialty. 2. 3. To assess competency in core procedural skills To assess professional conduct expected of a specialist

2. Duration Of Pre-Gazetment Period Minimum period of 6 months supervision 3. Assessment Tools 1. Observation and supervision of supervisee in the management of patients in the clinic, ward and operation theatre (if applicable) 2. 3. 4. Review of records of procedures and surgeries performed where relevant. Mid-term Interview Written feedback by team member

4. Expected Outcome 1. Understanding of the job description, role and responsibility of a specialist. 2. Demonstrate analytical skills in reaching at an appropriate diagnosis and formulating a comprehensive management plan. 3. Demonstrate knowledge on policies and procedures related to the conduct of core procedures. 4. 5. Demonstrate competence in the performance of core procedures. Adherence to professional ethics in the management of patient, relatives and colleagues

6.

Appreciate the importance of leadership, good governance, research and audit in clinical practice.

PERSONALITY ASSESSMENT

A. PERSONAL CHARACTERISTIC
Characteristics 1 Professional Attributes Punctuality Responsibility Availability Appearance / Attire /Hygiene Managerial Skill / Leadership Ability Relationship With Patient / Family Relationship With Fellow Professional & Collegues Relationship With Non Clinical Staff Poor 2 3 Fair 4 5 Good 6 Excellent 7 8

Remarks

1. Dynamic & Proactive 2. Moderate Enthusiasm 3. Passive 4. Disinterested & Indifferent 5. Others Please Specify :_____________________________________________

B. ACADEMIC & KNOWLEDGE

Criteria 1 Knowledge Journal Reading Teaching Ability Documentation & Record Keeping Case Presentation Conference / Service Attendence / Participation Research Activity QA Activity Case Write Up Involvement In Professional Bodies Involvement & Interest In CME Activities Poor 2 3 Fair 4 5 Good 6 Excellent 7 8

C. CLINICAL ABILITY
Patient Management 1 Interview Skill Physical Examination Clinical Judgement & Diagnostic Ability Decision Making Rationale Of Investigation Discussion / Case Presentation During Ward Round Promptness & Effectiveness In Treating Emergency Patients Competence & Appropriateness In Providing Continuing Care Remark : Poor 2 3 Fair 4 5 Good 6 Excellent 7 8

D.TECHNICAL & MANIPULATIVE SKILLS

Criteria 1 Patient Preparation & Procedures Surgical Skills Post Op Care Rate Of Complications Surgical Temperament & Ability To Cope With Stress Emergency Care & Procedures Safety Measure & Cleanliness Speed & Respect To Duration Anaesthesia Relationship With Anaesthetist, Assistants & Theatre Nurses Pre-Op

Poor 2 3

Fair 4 5

Good 6

Excellent 7 8

Remarks : (Please Attach Summary Of Core Procedures Performed From The Log Book)

FORMAT OF NARRATIVE REPORT

(Supervisor Report) This narrative report should include the following assessment criteria: 1. Personal Characteristics 2. Academic & knowledge 3. Clinical competence: a) Inquiry skill b) Problem solving & decision making c) Patient management (pre-operative, post operative and follow up including emergency cases) d) Technical skill e) Knowledge

4. Personal learning & assignment 5. Social & communication skill 6. Documentation & Record keeping 7. Participation in teaching learning activities 8. Recommendations on suitability for gazettement

Certified by :Name: .. Designation: . Official Cop: . Date: ....

MINISTRY OF HEALTH MALAYSIA

GAZETTEMENT LOG BOOK

ANAESTHESIOLOGY

SUMMARY OF CORE PROCEDURES PERFORMED` (ANAESTHESIOLOGY)

No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. Sympathetic Nerve Block Other Procedures Central Neural Blockage Thorax & Abdomen Peripheral Nerve Block: Lower Limb Regional Anaesthetic Techniques Peripheral Nerve Block: Upper Limb IV Lines Procedures Observed Airway management Mask Holding Technique Head Tilt Chin Lift & Jaw Trust Maneuver Orotracheal & Nasotracheal Intubation Cricothyrotomy Setting peripheral lines Central Venous Cannulation Intraarterial Cannulation Insertion of Pulmonary Artery Flotation Catheter (Swan Ganz) Local Infiltration Interscalene Brachial Plexus Block Supraclavicular Brachial Plexus Block Axillary Brachial Plexus Block Intercostal Nerve Block Ulnar,Median & Radial Nerve Block Wrist Block Digital Nerve Block Of Finger Sciatic Nerve Block Femoral,Obturator & Lateral Cutaneous Nerve Block 3 in 1 Block Tibial Nerve Block Common Peroneal Nerve Block Saphenous Nerve Block Deep Peroneal Nerve Block Digital Nerve Block Of Toe Intercostal Nerve Block Interpleural Local Anaesthesia Paravertebral Nerve Block Pudendal Nerve Block Epidural : Lumbar & Thoracic Approach Caudal Block Spinal Anaesthesia Stellate Ganglion Block Insertion Of Chest Tube Pericardiocentesis Bronchoscopy Cardiopulmonary Resuscitation With Defibrillation Number of procedures Assisted Done Independently

10

LOG OF PROCEDURES PERFORMED

(please continue at other pages if necessary)

NO

DATE

PROCEDURES

NAME / IC PATIENT

DIAGNOSIS

*O / A / P

CONSULTANT COMMENTS

*Please choose either observed (O),assisted (A) and performed (P) for the procedures done

11

MINISTRY OF HEALTH MALAYSIA

GAZETTEMENT LOG BOOK

INTERNAL MEDICINE

12

SUMMARY OF CORE PROCEDURES PERFOMED (INTERNAL MEDICINE)

No. Cardiology 1. Stress Test 2. Basic Echocardiogram (Diagnosis Of Pericardial Effusion, Mitral Stenosis, Assessment Of Left Ventricular Function) Dermatology 3. Skin Biopsy 4. Skin Scrapping For Diagnosis Of Fungal Infection 5. Tzanck Smear For Diagnosis Of Viral / Fungal Infection Hematology 6. Bone Marrow Aspiration/Trephine Biopsy Nephrology 7. Peritoneal Dialysis 8. Insertion Of Double Lumen Catheter Via Internal Jugular/Subclavian Vein 9. Urine Phase Contrast Examination Rheumatology 10. Intra-articular Injection & Aspiration Of Knee Joint Respiratory Medicine 11. Pleural Biopsy 12. Chest Tube Insertion 13. Medical Pleurodesis Procedures Number Of Procedure Performed Observed Assisted Done Independently

13

LOG OF PROCEDURES PERFORMED

(please continue at other pages if necessary)

NO

DATE

PROCEDURES

NAME / IC PATIENT

DIAGNOSIS

*O / A / P

CONSULTANT COMMENTS

*Please choose either observed (O),assisted (A) and performed (P) for the procedures done

14

MINISTRY OF HEALTH MALAYSIA

GAZETTEMENT LOG BOOK

OBSTETRIC & GYNAECOLOGY

SUMMARY OF CORE PROCEDURES PERFORMED (OBSTETRIC & GYNAECOLOGY)

No. Procedures Observed 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Vaginal delivery of twin pregnancy Vaginal Breech delivery Vacuum extraction Forceps Delivery Complicated Caesarian Section Cervical Cerclage Manual removal of placenta Replacement of uterine inversion Management of shoulder dystocia Repair of extended/ 3 perineal tear Repair of ruptured uterus External cephalic version Level II U/S examination Suction & Curettage Colposcopic examination & procedure Cone biopsy/LLETZ/Electrodiathermy Anterior Colporraphy Posterior Colpoperineorrhaphy Vaginal hysterectomy Abdominal hysterectomy Myomectomy Oopherectomy Omentectomy Ovarian cystectomy Bilateral tubal ligation Laparoscopic diagnostic -therapeutic -Adhesiolysis -Salphingolysis -Ovarian drilling Cystoscopy Hysteroscopic-diagnostic Intrauterine insemination U/S examination-abdominal, transvaginal (including follicular tracking) Number of procedures Assisted Done Independently

27 28 29 30

LOG OF PROCEDURES PERFORMED

(please continue at other pages if necessary)

NO

DATE

PROCEDURES

NAME / IC PATIENT

DIAGNOSIS

*O / A / P

CONSULTANT COMMENTS

*Please choose either observed (O),assisted (A) and performed (P) for the procedures done

MINISTRY OF HEALTH MALAYSIA

GAZETTEMENT LOG BOOK

PAEDIATRICS

SUMMARY OF CORE PROCEDURES PERFORMED (PAEDIATRICS)

No 1 2 3 4 5 6 7 8 9 Procedure Lumbar Puncture Chest tube insertion Suprapubic tap Basic ventilation Surfactant administration Endotracheal intubation Central venous/long line insertion Arterial puncture/cannulation Bone marrow aspiration and trephine biopsy 10 11 12 13 Intraosseous cannulation DC cardioversion/defibrillation Peritoneal dialysis Umblical artery and vein cannulation 14 15 16 17 Ultrasound brain Neonatal resuscitation Exchange transfusion Paediatric advanced life support Completed Signature /designation

LOG OF PROCEDURES PERFORMED

(please continue at other pages if necessary)

NO

DATE

PROCEDURES

NAME / IC PATIENT

DIAGNOSIS

*O / A / P

CONSULTANT COMMENTS

*Please choose either observed (O),assisted (A) and performed (P) for the procedures done

MINISTRY OF HEALTH MALAYSIA

GAZETTEMENT LOG BOOK

ORTHOPAEDIC

SUMMARY OF CORE PROCEDURES PERFORMED (ORTHOPAEDICS)

No. 1 2 Procedures Close reduction of dislocation or fractures Application of skin and skeletal traction, Steinmann pin insertion, cervical tong skull traction Halo vest application Application of POP and other casts External fixation of extremities and also pelvic fractures. Wound debridement and fixation of open fractures. Plating of long bone fractures Intramedullary nailing Interlocking nailing DHS fixation Hemiarthroplasty Angle blade plate fixation Plating / fixation of phalanges Local wound closure procedures local flap, rotation flap, SSG Amputation (BKA, AKA, etc) Fasciotomy for compartment syndrome Nerve, tendon or arterial repair Posterior spine stabilisation Excision biopsy of superficial benign soft tissue tumours Release of entrapment syndrome Incision and drainage of abscess Arthrotomy of joint (septic arthritis) Bone grafting procedures Sequestractomy Primary arthroplasty (hip and knee) Laminectomy / laminotomy and discectomy Diagnostic arthroscopy and simple therapeutic procedures Simple osteotomy procedures Simple pediatric orthopaedic procedures Soft tissue procedures for simple soft tissue deformity Number Of Precedure Performed Observed Assisted Done Independently

3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

LOG OF PROCEDURES PERFORMED

(please continue at other pages if necessary)

NO

DATE

PROCEDURES

NAME / IC PATIENT

DIAGNOSIS

*O / A / P

CONSULTANT COMMENTS

*Please choose either observed (O),assisted (A) and performed (P) for the procedures done

MINISTRY OF HEALTH MALAYSIA

GAZETTEMENT LOG BOOK

OTORHINOLARYNGOLOGY (ENT)

SUMMARY OF CORE PROCEDURES PERFORMED (OTORHINOLARYNGOLOGY)

No Procedures Observed No Of Procedures Assisted Done independently Rhinology 1. Submucous diathermy of inferior turbinates 2. Antral washout 3. Antrostomy 4. Endoscopic Sinus Surgery 5. Trimming inferior turbinates 6. Nasopharyngoscopy 7. Ethmoidectomy (intranasal & external) 8. Frontal sinus trephination 9. Lateral rhinotomy 10. Rhinoplasty 11. Septorhinoplasty 12. Caldwel Luc & transantral procedures 13. Maxillectomy (partial, total, with orbital exentration) Otology 14. Tympanoplasty 15. Mastoidectomy(Cortical , modified radical, radical) 16. Aural polypectomy 17. Myringotomy 18. Grommet insertion Laryngology, Head and Neck 19. Tonsillectomy/adenoidectomy 20. Excision of head & neck cyst and sinuses 21. Bronchoscopy 22. Parotidectomy(superficial& total) 23. Salivary gland surgery 24. Commando Surgery 25. Laryngectomy(partial & total) 26. Endoscopic laryngeal microsurgery 27. Neck Dissections (all types) 28. Lateral pharyngotomy 29. Facial fracture reduction 30. Local Flaps and reconstructions Emergency Procedures 31. Oesophagoscopy and Foreign Body Removal 32. Bronchoscopy and Foreign body removal 33. Epistaxis Management 34. Drainage of Deep Neck Abscess 35. Facial Fractures Reduction 36. Tracheostomy

LOG OF PROCEDURES PERFORMED

(please continue at other pages if necessary)

NO

DATE

PROCEDURES

NAME / IC PATIENT

DIAGNOSIS

*O / A / P

CONSULTANT COMMENTS

*Please choose either observed (O),assisted (A) and performed (P) for the procedures done

MINISTRY OF HEALTH MALAYSIA

GAZETTEMENT LOG BOOK

OPHTHALMOLOGY

CONTENTS 1. Overview 1.1. Objectives 1.2. Core Procedures 1.3. Assessment Tools 1.4. Expected Outcome

Page 2-3

2. Record of Specialist Supervision 2.1. Trainee Time Table 2.2. Chronological Procedures Record 2.3. Chronological Surgical Procedures Record 2.4. Core Procedural Skills Record (Summary) 2.5. Core Procedures Assessment 2.6. Clinical Competency Assessment 2.7. Overall Competency Assessment 2.8. Narrative Report 2.9. Summary of Performance Assessment 3. Specialist Supervision Orientation Program 3.1. Overview of supervision 3.2. Role of supervisee 3.3. Role of supervisor/head of department 3.4. Job Description on completion of supervision 4 5 6 7 8 9-13 14 15 16 17-18

SPECIALIST SUPERVISION OBJECTIVES A. General Objective To assess the competency of medical officers on completion of specialist training in Ophthalmology B. Specific Objective 4. To assess clinical skills in diagnosis and management of patients with common ocular disorders. 5. To assess competency in core procedural skills 6. To assess professional conduct expected of a specialist C. Duration Minimum period of 6 months supervision D. Core procedures 1. Cataract Surgery 1.1. ECCE with or without IOL implant 1.2. Phacoemulsification with or without IOL implant 1.3. Lens Aspiration with or without IOL implant (in children 2 years and above) 2. Glaucoma Filtering Surgery-Trabeculectomy 3. Strabismus Correction 4. Enucleation/Evisceration 5. Simple Entropion and Ectropion surgery 6. Tarsorrhaphy 7. Toilet and suturing-cornea/sclera 8. Toilet and suturing-eyelid 9. Vitreous Tap/Vitreous Biopsy/Intravitreal Injection 10. Excision of pterygium and conjunctival mass 11. Incision and drainage of orbital/lid abscess 12. Incision and curettage of chalazion 13. Syringing and Probing 14. Cycloablative procedure (cyclocryotherapy/cycloablation) 15. Laser Procedures 15.1. Direct Pan Retinal Photocoagulation

15.2. 15.3. 15.4. 15.5. 15.6. 15.7. 15.8.

Indirect Pan Retinal Photocoagulation Focal Laser for Diabetic Maculopathy Focal Laser for Retinal Breaks/Retinal Degeneration Peripheral Iridectomy Peripheral Iridectomy YAG Laser Iridotomy YAG Laser Posterior Capsulotomy

E. Assessment Tools 5. Observation and supervision of supervisee in the management of patients in the clinic, ward and operation theatre 6. Review of records of procedures and surgeries performed. 7. Mid-term Interview 8. Written feedback by team member 9. Objective assessment of surgical competence in cataract surgery using CUSUM Scoring system (future development) F. Expected Outcome 7. Complete the Specialist Orientation Program on job description and expectations during period of supervision. 8. Demonstrate analytical skills in reaching at an appropriate diagnosis and formulating a comprehensive management plan. 9. Demonstrate knowledge on policies and procedures related to the conduct of core procedures. 10. Demonstrate competence in the performance of core procedures. 11. Adherence to professional ethics in the management of patient, relatives and colleagues 12. Appreciate the importance of leadership, good governance, research and audit in clinical practice.

SUPERVISEE TIME TABLE SUPERVISEE ROTATION AT ________________________________________ SUPERVISING CONSULTANT ________________________________________ FROM __________________ TO _________________

WEEKLY TIME TABLE

DAY Sunday a.m. Sunday p.m. Monday a.m. Monday p.m. Tuesday a.m. Tuesday p.m. Wednesday a.m. Wednesday p.m. Thursday a.m. Thursday p.m. Friday a.m. Friday p.m. Saturday a.m. Saturday p.m. ACTIVITY CONSULTANT

REGULAR TEACHING SESSIONS

Sessions Frequency

Chronological Procedures Record (Key: P= Performed without supervision; PS= Performed under supervision; SJ= Supervising a junior)
Please tick ()

Date

MRN

Diagnosis

Procedure

PS

SJ

Complications

Remarks

----------------------------------------------------------Supervisors Signature

.............................. Date

Chronological Surgical Record (Key: P= Performed without supervision; PS= Performed under supervision; SJ= Supervising a junior; A= Assistant; E= Emergency)
Please tick ( )

Date

MRN

Diagnosis

Operation

P S

SJ

Outco me

Compli cations

Remar ks

Pre op VA

Visual Outcome Post op Post op unaided BCVA

Refraction

----------------------------------------------------------Supervisors Signature

-----------------Date

CORE PROCEDURAL SKILLS ON COMPLETION OF GAZETTEMENT

(Applicable to employees of Government hospitals) SUMMARY SHEET

No Procedures (Please insert number performed in each category) P PS SJ A E

1. 1Cataract Surgery 1.1 ECCE with or without IOL implant 1.2 Phacoemulsification with or without IOL implant 1.3 Lens Aspiration with or without IOL implant (in children 2 years and above) 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Glaucoma Filtering Surgery-Trabeculectomy Strabismus Correction Enucleation/Evisceration Simple Entropion and Ectropion surgery Tarsorrhaphy Toilet and suturing-cornea/sclera Toilet and suturing-eyelid Vitreous Tap/Vitreous Biopsy/Intravitreal Injection Excision of pterygium and conjunctival mass Incision and drainage of orbital/lid abscess Incision and curettage of chalazion Syringing and Probing Cycloablative procedure (cyclocryotherapy/cycloablation) 15. 4Laser Procedures Direct Pan Retinal Photocoagulation Indirect Pan Retinal Photocoagulation Focal Laser for Diabetic Maculopathy Focal Laser for Retinal Breaks/Retinal Degeneration Peripheral Iridectomy YAG Laser Iridotomy YAG Laser Posterior Capsulotomy (Key: P= Performed without supervision; PS= Performed under supervision; SJ= supervising a junior; A= Assistant; E= Emergence)

CORE PROCEDURES ASSESSMENT ASSESSMENT SCORE: A - Supervising a junior B - Performed without supervision C - Performed under supervision D - Assistant

No 1.

Procedures Cataract Surgery 1.1 ECCE with or without IOL implant 1.2 Phacoemulsification with or without IOL implant 1.3 Lens Aspiration with or without IOL implant (in children 2 years and above) Glaucoma Filtering Surgery-Trabeculectomy Strabismus Correction Enucleation/Evisceration Simple Entropion and Ectropion surgery Tarsorrhaphy Toilet and suturing-cornea/sclera Toilet and suturing-eyelid Vitreous Tap/Vitreous Biopsy/Intravitreal Injection Excision of pterygium and conjunctival mass Incision and drainage of orbital/lid abscess Incision and curettage of chalazion Syringing and Probing Cycloablative procedure (cyclocryotherapy/cycloablation) Laser Procedures Direct Pan Retinal Photocoagulation Indirect Pan Retinal Photocoagulation Focal Laser for Diabetic Maculopathy Focal Laser for Retinal Breaks/Retinal Degeneration Peripheral Iridectomy YAG Laser Iridotomy YAG Laser Posterior Capsulotomy

Assessment Score Self Supervisor

Date: Date:

2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Note: Format to be filled at the start of supervision, mid term review and at the end of supervision period.

CLINICAL COMPETENCY ASSESSMENT

Date : _____________________________ Assessment No.: ____________________________ Training Duration: ___________________________ Trainee`s name: _____________________________ Trainee`s signature : _________________________ Hospital : __________________________________ Supervising Consultants name: ______________________________ Supervising Consultants signature: ___________________________ Posting : ____________________________

Please mark the box which corresponds with your observations in each category. Please make judgements according to the criteria outlined below and not according to your experience with other students under your supervision. The behaviours outlined in the first box in each category is the gold standard by which the student should be judged. A tick here indicates excellent performance. Ticks in the other boxes indicate performance that is good, satisfactory, further improvement necessary ( i.e borderline ), further improvement essential ( i.e weak ) in descending order.

1. Clinical Competence 1.1 Inquiry skills ( obtaining data / information from history, physical examination and

investigations )
Excellent

Consistently elicits problem-related data from patient and other relevant sources, stresses important points, well organized approach. Consistently elicits and interprets correctly all signs, technical and organizational approach consistently good. Consistently plans and interpret investigations appropriate to the problem with attention to specificity, reliability, patient safety and comfort, cost and explains reasons for and nature of investigations to patient.

Good Satisfactory

As above but less consistently. As above, but sometimes concentrate on data not related to the problem, sometimes omits to consult other sources, occasionally misses important signs. Occasionally request investigations not appropriate to the problem and / or without attention to specificity, reliability, etc, sometimes miss important data. Approach not well organized, not always problem related, frequently misses important data. Approach technically imperfect and not very systematic, frequently misses important physical signs.

Borderline

Frequently request investigations not appropriate to the problem and/ or without attention to specificity, reliability, patient safety, misses important data. Weak Approach not organized, frequently problem related, important data missed on most occasions. Approach technically unacceptable and not systematic, important signs missed on most occasions. Consistently makes inappropriate decisions in ordering investigations, consistently misinterprets and/ or misses important data. 1.2 Problem solving and decision- making skills Diagnostic ability Excellent Consistently makes careful reasoned deductions from available data ( history, physical examination, investigations )to arrive at the appropriate decision. As above, but less consistently. As above, but occasionally makes incorrect deductions. Most times able to give correct provisional diagnosis but not all relevant differential diagnosis. Frequently does not follow a logical approach to deduction from the available data, frequently gives incorrect provisional diagnosis. Illogical reasoning and deductions. Frequently makes incorrect diagnosis.

Good Satisfactory

Borderline

Weak

Patient Management ( pre operative post operative and follow up including emergencies ) Excellent Consistently suggests appropriate management, exhibits awareness of the role and possible complications of the proposed intervention ( e. g adverse drug reaction, surgical morbidity ), self reliant and conscientious in approach,involves patient and family in management decisions. As above, but less consistently. As above, but occasionally suggests inappropriate management. Shows some lack of awareness of role of proposed interventions and their possible complications, is unsure/not Conscientious in implementing management. Frequently makes inappropriate management decisions.

Good Satisfactory Borderline

Weak

1.3 Technical skills Excellent Consistently carries out procedures and operative tasks with an appropriate level of technical skill and with due consideration for the patient. As above, but less consistently As above, but is not equally skilled in all procedures Not skilled in most procedures, occasionally exhibits lack of consideration and/or care and attention to detail. Serious lack of skill in a number of procedures, frequently exhibits lack of care and attention to detail, not considerate to patients.

Good Satisfactory Borderline Weak

2. Knowledge Excellent Good Satisfactory Consistently applies appropriate knowledge of basic and clinical sciences to the solution of patient problems. As above, but less consistently As above, but occasional gaps in knowledge and/or difficulty in application to patient problems. However makes effort to seek information. Inadequate knowledge and/or difficulty in application to patient problems. Sometimes make effort to seek information. As in borderline information. but lacks initiative in seeking

Borderline

Weak

3. Professional Characteristics Excellent Shows evidence of professional qualities: accepting responsibility, being caring, thorough, reliable, available, punctual, trustworthy and respecting confidentiality As above, but less consistently or as effectively. As above, but with occasional deficiencies in professional qualities as defined above. Frequently deficient in areas defined above Consistently deficient in areas defined above.

Good Satisfactory Borderline Weak

4. Personal Learning and Assignments. Excellent Consistently manages own learning by asking questions and searching for the answer in journals, books and consultation, improves progress as a learner and as a future surgeons by seeking feedback and acting on the latter, willing to teach others, conscientious in completing assignments : case write ups, audits, log book, dissertation. As above, but less consistently or as effectively As above, but with occasional deficiencies in self directed learning, self monitoring Frequently deficient in areas defined above. Consistently deficient in areas defined above.

Good Satisfactory Borderline Weak

5. Conduct and communication skills

Excellent

Consistently in communication with patients, listens and is sensitive to the needs of the patient; comforts the patients; gives equal priority to the person ans the illness; establishes and maintains an open but objective relationship with the patient; recognizes that the patients attitude to the doctor affects patients reactions/behaviour, provides clearly understood information. Consistently communicating/working with other professionals, is courteous, sensitive to needs of others; fulfils role in the team appropriately by collaborating readily with others; provides clear information, instruction/advice to others; readily accepts reasonable advice/criticism from others.

Good Satisfactory Borderline Weak

As above, but less consistently or as effectively As above, but with occasional deficiencies in communicating skills outlined above. Frequently deficient in communicating skills outlined above. Consistently deficient in communicating skills outlined above.

6. Record Keeping Excellent Consistently records legibly, updates accurately patients problems and management progress, with emphasis on own observations, and provides regular informative summary of progress. As above, but less consistently. As above, but occasionally one or more aspects of record keeping inadequate Records are frequently illegible, inaccurate, and poorly organized. not up-to-date,

Good Satisfactory Borderline Weak

Records are consistently inadequate according to above criteria.

7. Participation in Teaching-learning Activities.

Excellent Ward round Clinic Case Presentation Tutorial OT Teleconference Xray/CPC, Morbidity/ Mortality conference etc

Good

Satisfactory

Borderline

Weak

OVERALL ASSESSMENT
Overall clinical competence Excellent Good Satisfactory Borderline (Further improvement desirable) Weak (Further improvement essential)

Comment by Supervisor

..................................................
Name and signature of supervisor

Comment by Head of Department

Name and signature of Head of Department

NARATIVE REPORT

SUMMARY OF PERFORMANCE ASSESSMENT

Name : ______________________________ Period of Assessment/ Supervision Name of Immediate Supervisor (s) Assessment report by supervisor Recommendation Prescribed Remedial measure Candidates exceptions report Reassessment

Date : ______________

Decision

. Supervisors signature

SPECIALIST ORIENTATION PROGRAMME SCOPE 1. Overview of the period of supervision General and specific objective, core procedures, assessment tools , and expected outcome 2. Role of the supervisee 2.1. Be fully aware of the job description during and after the supervision period (refer to item 4) 2.2. Regular up keeping of log book and self auditing 2.3. Seek every opportunity to demonstrate skills (soft skills, clinical, technical) acquired during training 2.4. Performance of core procedure and achieve accepted standards of outcome measure. 2.5. Participate actively in department CME programmes as well as community projects 2.6. Participate in departmental Audit or QA activities where necessary. 3. Role of the supervisor/head of department 3.1. Provide orientation to and assign the duties of the supervisee 3.2. Oversee and ascertain the clinical and surgical competence of supervisee in the various clinical settings 3.3. Supervise performance of procedures and regular review of supervisees log book 3.4. Conduct progress interview at midterm or periodically where necessary and record in the supervision record and logbook. 3.5. Facilitate further training if required especially in areas of weaknesses. 3.6. Prepare a narrative report at the end of the supervision period and make recommendations to the Jawatankuasa Khas Perubatan.

4. Job description of Specialist upon completion of period of supervision 4.1. Conduct clinic sessions, perform on call duty and ward rounds. 4.2. Performance of core procedures and achieve accepted standards of outcome measure. 4.3. Organise training programmes 4.3.1. In house teaching sessions of junior medical officers and paramedical staff 4.3.2. Primary Eye Care Courses 2 courses each for medical officers and paramedics annually 4.3.3. Postgraduate training if applicable 4.3.4. Ophthalmic Nursing Programme if applicable 4.4. Conduct continuous quality improvement activities at departmental level 4.5. Conduct prevention of blindness activities 4.5.1. district hospital visit 4.5.2. out- reach programmes 4.5.3. health promotion activities 4.6. Perform administrative duties to ensure smooth running of services and training programmes.

MINISTRY OF HEALTH MALAYSIA

GAZETTEMENT LOG BOOK

PSYCHIATRY

TYPES OF CASES SEEN OVER THE LAST 6 MONTHS IN PSYCHIATRY

No. 1. 2. 3. 4. 5. 6. 7. 8. 9.

Cases General Adult Psychiatry Child & Adolescent Psychiatry Old Age Psychiatry Liaison Psychiatry Forensic Psychiatry Community Psychiatry Rehabilitation Psychiatry Substance Abuse Psychoeducation

No. of cases

10. Medical Board Meeting (Lembaga Perubatan) 11. Specialist Medical Report

INDICATE RANGE OF TREATMENT OPTIONS USED IN THE LAST 6 MONTHS

No 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Treatment Individual Counselling Individual Psychotherapy Parental Counselling Marital Therapy Family Therapy Cognitive Behaviour Therapy Group Therapy Drug Treatment ECT Others (please specify) Used No. Of Treatment

LOG OF PROCEDURES PERFORMED

(please continue at other pages if necessary)

NO.

DATE

PROCEDURES

NAME / IC PATIENT

DIAGNOSIS

*O / A / P

CONSULTANT COMMENTS

*Please choose either observed (O),assisted (A) and performed (P) for the procedures done

MINISTRY OF HEALTH MALAYSIA

GAZETTEMENT LOG BOOK

RADIOLOGY

SUMMARY OF CORE PROCEDURES PERFORMED (RADIOLOGY)

No: Procedure Observed Assist Perform Independently Candidates Initials

Mandatory 1. Supervision And Interpretation Of Conventional Radiographic Examinations Contrast Studies Of G.I. And Biliary Tract Contrast Studies Of GenitoUrinary Tract Ultrasound Diagnostic Interpretation Ultrasound Guided Interventional Procedures Doppler Sonography CT Diagnostic Interpretation CT Guided Interventional Procedures Mammography MRI Diagnostic Interpretation Department Clinical Audit CME Department / Hospital Presentation Percutaneous Biopsies Percutaneous Drainage Peripheral Venography Angiography Diagnostic

2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 1. 2.

Preferred

LOG OF PROCEDURES PERFORMED

(please continue at other pages if necessary)

NO

DATE

PROCEDURES

NAME / IC PATIENT

DIAGNOSIS

*O / A / P

CONSULTANT COMMENTS

*Please choose either observed (O),assisted (A) and performed (P) for the procedures done

MINISTRY OF HEALTH MALAYSIA

GAZETTEMENT LOG BOOK

SURGERY

SUMMARY OF CORE PROCEDURES PERFORMED (SURGERY)

No Procedures Observed 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 Head & Neck Submandibular gland excision Hemithyroidectomy Sub total thyroidectomy Total Thyroidectomy Thyroglossal cystectomy Preauricular sinuses Tracheostomy Neurosurgery Burrholes Craniotomy-extradural /subdural haemorrage Craniotomy Breast Lumpectomy Mastectomy Axilliary Dissection Mastoidochotomy Hookwire localization biopsy Hernias All hernia repairs Endoscopy Upper GI Endoscopy Lower GI Endoscopy Vascular Femoral Artery Embolectomy Vascular access Vascular trauma Varicose vein surgery Gastrointestinal Perforated peptic ulcer Gastrojejunostomy Pyloroplasty Under running of bleeding ulcers Partial gastrectomy Gastrostomy Repair diaphragmatic tear Small bowel resection/anastomosis Right hemicolectomy Haemorroidectomy Simple fistula in Ano Lateral Sphincterotomy Hepatobiliary No of Procedures Assisted Done Independently

No 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54

Procedures Observed Open cholecystectomy Lap Cholecystectomy Surgery for liver trauma Spleenectomy Pancreatic necrosectomy Urology Vesicolithotomy Varicocoele Hydrocoele Cystoscopy Retrograde Pyelography Ureterolithotomy Neprectomy Plastic Surgery Split skin graft Simple reconstruction eg V-Y, plasty Paediatric Surgery Hernia Hydrocoele Intussusception Laparotomy for acute abdomen Appendicectomy Spleenectomy

No of Procedures Assisted Done Independently

LOG OF PROCEDURES PERFORMED

(please continue at other pages if necessary)

NO

DATE

PROCEDURES

NAME / IC PATIENT

DIAGNOSIS

*O / A / P

CONSULTANT COMMENTS

*Please choose either observed (O),assisted (A) and performed (P) for the procedures done