Please use a CROSS (X) for each question and complete this form in BLOCK CAPITALS and BLACK ink. Trainee’s surname Trainee’s forename(s) GMC Number GMC NUMBER MUST BE COMPLETED Hospital placement: Duration of placement: Total beds: Level 2: Level 3: Mixed 2/3: Level of training: Core Step 1 Step 2 Step 3 Speciality: General Cardiac Neuro Paeds Total unit admissions during placement: Event Local supervision Distant supervision Teaching Ward review Admission Lead ward round Cardiac arrest Trauma team Intra-hospital transfer Inter-hosptial transfer Discussion with relatives End of life care/donation Procedure Local supervision Distant supervision Teaching Emergency intubation Percutaneous tracheostomy Bronchoscopy Lungs & Chest drain - seldinger Chest drain – blunt dissection Airway Lung ultrasound Arterial cannulation Central venous access – IJ Central venous access – SC Central venous access – Femoral Pulmonary artery catheter Cardiovascular Non-invasive CO monitoring Echocardiogram Ascitic drain/tap Sengstaken tube placement Abdominal ultrasound/FAST Abdomen Lumbar puncture Brainstem death testing CNS Experience of the all the above procedures is desirable but NOT essential
Please use a CROSS (X) for each question and complete this form in BLOCK CAPITALS and BLACK ink. Trainee’s surname Trainee’s forename(s) GMC Number GMC NUMBER MUST BE COMPLETED Hospital placement: Duration of placement: Total beds: Level 2: Level 3: Mixed 2/3: Level of training: Core Step 1 Step 2 Step 3 Speciality: General Cardiac Neuro Paeds Total unit admissions during placement: Event Local supervision Distant supervision Teaching Ward review Admission Lead ward round Cardiac arrest Trauma team Intra-hospital transfer Inter-hosptial transfer Discussion with relatives End of life care/donation Procedure Local supervision Distant supervision Teaching Airway & Lungs Emergency intubation Percutaneous tracheostomy Bronchoscopy Chest drain - seldinger Chest drain – blunt dissection Lung ultrasound Cardiovascular Arterial cannulation Central venous access – IJ Central venous access – SC Central venous access – Femoral Pulmonary artery catheter Non-invasive CO monitoring Echocardiogram Abdomen Ascitic drain/tap Sengstaken tube placement Abdominal ultrasound/FAST CNS Lumbar puncture Brainstem death testing Experience of the all the above procedures is desirable but NOT essential
ficm_logbook_summary_2012.docx