Conjoint Committee of the Diploma of Obstetrics & Gynaecology (CCDOG) The Royal Australian and New Zealand College

of Obstetricians and Gynaecologists

CERTIFICATE OF WOMENS HEALTH WORKPLACE-BASED VALIDATION FORM - ANTENATAL EXAMINATION

TRAINEE DETAILS (please print clearly)
Surname: ______________________________ Given name: ___________________ RANZCOG ID #: _________

INSTRUCTIONS TO TRAINEES: 1. Thoroughly familiarise yourself with the criteria and the clinical descriptors for Below MAPS, At MAPS, and Above MAPS. 2. Arrange a suitable time to undertake the WBV with your Training Mentor. 3. Provide your Training Mentor with the appropriate WBV form. NB: Each WBV has its own form with criteria and clinical descriptors specific to the particular skill being assessed. You must ensure that the correct WBV form is being used for the particular WBV you are undertaking. 4. If the WBV is being repeated, a new form must be used. NB: If you receive a Below MAPS or Not Observed for one (1) or more criteria, the WBV is deemed unsatisfactory and must be repeated until at least AT MAPS is achieved on all criteria. 5. After the WBV is completed, you must: i) Discuss the WBV with the Training Mentor. You should receive feedback on your performance in line with the criteria on the WBV form. If the WBV is marked as unsatisfactory, you must be given specific feedback on the areas that require improvement. ii) Sign the form. Have the Training Mentor sign the form. iii) The Training Mentor keeps a copy of the form for their records. You keep the originals of all forms (both unsatisfactory and satisfactory) in the plastic pocket at the back of your Logbook. NB: When you submit your Logbook to RANZCOG at the conclusion of your training, only submit the satisfactory WBV forms. INSTRUCTIONS TO TRAINING MENTORS: 1. Your Trainee will arrange a suitable time to undertake the WBV and provide you with the relevant form. Each WBV has a different form with criteria and clinical descriptors for Below MAPS, At MAPS, and Above MAPS specific to the skill being assessed. In order to more effectively facilitate the assessment process, familiarise yourself, whenever possible, with the criteria and clinical descriptors before the WBV activity. The forms are available on the RANZCOG website at: http://www.ranzcog.edu.au/trainees/diploma-trainees.shtml. 2. If the WBV is being repeated, a new form must be used. NB: If you give a Below MAPS or Not Observed for one (1) or more criteria, the WBV is deemed unsatisfactory and must be repeated until the trainee achieves at least AT MAPS on all criteria. 3. After the WBV is completed, you must: i) Discuss the WBV with the Trainee. You should give feedback on the trainees performance in line with the criteria on the WBV form. If the WBV is marked as unsatisfactory, you must give specific feedback on the areas that require improvement. ii) Sign the form. Have the Trainee sign the form. iii) Keep a copy of the form for your records. The Trainee must keep the originals of all forms (both unsatisfactory and satisfactory) in the plastic pocket at the back of their Logbook.

VALIDATION CRITERIA & COMMENTS

VALIDATION CRITERIA
BELOW MAPS Neither obtained permission from patient to conduct examination nor explained why it was being done. Frequently used unnecessary force or caused discomfort to patient Deficient knowledge. Needed specific instruction to conduct most aspects of the examination Did not communicate any findings of the examination to the patient. Irrelevant, inadequate or inappropriate for presentation / patient / setting.

CLINIICAL DESCRIPTORS (please circle one clinical descriptor per criterion)

AT MAPS Obtained permission to conduct examination from patient but did not explain why it was being done. Carefully and respectfully examined patient, but used some unnecessary force and/or caused some discomfort Knew important aspects of examination ABOVE MAPS Obtained permission to conduct examination from patient and explained why it was being done. Consistently examined patient respectfully, without causing undue discomfort Demonstrated clear understanding of all steps in examination Clearly and concisely communicated and explained all findings Comprehensive, relevant & appropriate for presentation / patient / setting. NOT OBSERVED Not observed

Consent &/or explanation:

Respect of patient:

Not observed

Knowledge of examination: Communication and explanation of findings: Management plan:

Not observed

Communicated important findings to the patient without explanations Some key aspects missing, irrelevant or inappropriate for presentation / patient / setting.

Not observed Not observed

TRAINING MENTORS COMMENTS (to be discussed with Trainee) 1. I was impressed by:

2. I would like to see more of:

3. Agreed action (if applicable):

VALIDATION RESULT: SATISFACTORY _______ Number of validations (including this one) required to achieve this outcome UNSATISFACTORY validation to be repeated until at least AT MAPS is achieved on all criteria.

Training Mentors name: ________________________________________ Date of validation: ______________

Training Mentors signature: ____________________________________________ The Training Mentor has discussed this validation with me.

Trainees signature: ____________________________________________________ Date: ________________