Previous placements in OM programme Employer/ Clinical supervisor Dates Current placement ( Has your ES changed since the last ARCP outcome-Y/N) Location Specialty Clinical supervisor Dates Work Place Based Assessments in current placements Assessment Dates Number Details Outcome ( or ( median or summary range of scores if (satisfactory/ attached) appropriate) unsatisfactory/ insufficient & evidence) Comments Mini-CEX SLE-DOPs CBD Activity Dates Details Outcome ( or (Required/ not required; summary (median or satisfactory/ unsatisfactory/ insufficient attached) range of & Comments evidence) scores if appropriate) MSF Patient survey SAIL(OH) 1 SAIL (OH) 2
Previous placements in OM programme Employer/ Clinical supervisor Dates Current placement ( Has your ES changed since the last ARCP outcome-Y/N) Location Specialty Clinical supervisor Dates Work Place Based Assessments in current placements Assessment Dates ( or summary attached) Number Details ( median or range of scores if appropriate) Outcome (satisfactory/ unsatisfactory/ insufficient evidence) & Comments Mini-CEX SLE-DOPs CBD Activity Dates ( or summary attached) Details (median or range of scores if appropriate) Outcome (Required/ not required; satisfactory/ unsatisfactory/ insufficient evidence) & Comments MSF Patient survey SAIL(OH) 1 SAIL (OH) 2
Section-4-Training-CPD-Record-June-2016_ESR17.docx