Name of clinical service provider: Name of person Designation: submitting the application: Contact details: Title of proposed Duration of proposed fellowship: post-CCT fellowship: Date submission received: Date submission sent to assessor(s): Name of Educational Designation: Guide: Is the Educational Guide YES/NO* If yes, approved by an approved Education whom: Supervisor? Educational Guide’s Meets supervisory/mentoring requirements/does not experience: meet requirements* Name of the unit(s) in Location of unit(s): which the fellow will be based: Does the remit of the YES/NO* If no (and there are no unit(s) and the workload plans for the fellow to undertaken by the unit experience other meet the requirements settings), describe what for a satisfactory learning would need to be put in experience? place by the clinical service provider. Do the job description YES/NO* If no, please recommend and job plan/timetable changes to the job provide for appropriate description and/or job experience to enable plan/timetable which satisfactory completion of would enhance the a post-CCT fellowship? experience of the fellow. Do the learning outcomes YES/NO* If no, please state why: for the post meet the requirements for a JRCPTB accredited fellowship as outlined in the Educational Standards Framework? Does the proposed Professional Skills If no, please describe fellowship adequately what amendments YES/NO* cover the requirements would need to be made for the core components before resubmission of Education of self and of the Educational the application and/or others Standards Framework what information is (either emphasis on at required in order to YES/NO*
Name of clinical service provider: Name of person submitting the application: Designation: Contact details: Title of proposed fellowship: Duration of proposed post-CCT fellowship: Date submission received: Date submission sent to assessor(s): Name of Educational Guide: Designation: Is the Educational Guide an approved Education Supervisor? YES/NO* If yes, approved by whom: Educational Guide’s supervisory/mentoring experience: Meets requirements/does not meet requirements* Name of the unit(s) in which the fellow will be based: Location of unit(s): Does the remit of the unit(s) and the workload undertaken by the unit meet the requirements for a satisfactory learning experience? YES/NO* If no (and there are no plans for the fellow to experience other settings), describe what would need to be put in place by the clinical service provider. Do the job description and job plan/timetable provide for appropriate experience to enable satisfactory completion of a post-CCT fellowship? YES/NO* If no, please recommend changes to the job description and/or job plan/timetable which would enhance the experience of the fellow. Do the learning outcomes for the post meet the requirements for a JRCPTB accredited fellowship as outlined in the Educational Standards Framework? YES/NO* If no, please state why: Does the proposed fellowship adequately cover the requirements for the core components of the Educational Standards Framework (either emphasis on at Professional Skills YES/NO* If no, please describe what amendments would need to be made before resubmission of the application and/or what information is required in order to Education of self and others YES/NO*
post-cct-application-process-checklist-26-nov-2013.docx