CMSA

PORTFOLIO OF LEARNING

Fellowship of the College of Dermatologists of South Afri a

FC DERM!SA"
From January 2011 only electronic versions of this document will be accepted.

PORTFOLIO OF LEARNING CONTENTS SECTION # SECTION $ SECTION % SECTION & SECTION ' SECTION ( SECTION ) SECTION * SECTION + SECTION #, Information Personal details Programmeme Supervisor s annual review !eports on rotations "umulative record of rotations "ontinuous assessments Procedures !esearch pro#ects$ academic presentations$ and teaching activities !ecord of leave ta%en &eclaration on completion of training

N-. Please read the !egulations and "urriculum for the F" &erm'S() e*amination at the start of training + details are available on the ",S( website or a hard copy can be obtained from the ",S( office or your Programmeme Supervisor
-in% to the latest electronic copy of the F" &erm'S() !egulations hosted on .he "olleges of ,edicine of South (frica /ebsite

SECTION # I0F1!,(.I10
The purpose of this portfolio is twofold: firstly, to document the details of your in-service training including procedures performed, which will assist your Programme Supervisor in assessing the adequacy of your clinical and technical exposure; and secondly, to provide you with an ongoing assessment of your progress which will be recorded at the end of each rotation !t must be filled in at the end of every rotation and will be reviewed by your "irm#$nit %ead &the Training Supervisor' (our Programme Supervisor should review your portfolio at least annually as part of a continuous assessment policy !t is a requirement of the )ollege of *ermatologists that your portfolio be submitted to your %ead of *epartment prior to entry to Part + and Part , of the ") *erm&S-' examinations to assess adequacy of completion of training $sing a separate page for each rotation, briefly describe your duties, giving a brea.down of the types and numbers of patients you have personally managed /ecord the details of procedures performed, academic presentations, teaching and research activities and any leave ta.en in the relevant sections of the portfolio 0a.e sure that your Training Supervisor in the 1ard#$nit has reviewed your entries and has signed in the space provided !n addition, he#she must complete the )ontinuous -ssessment "orm at the end of each rotation This portfolio can be used as a record of your experience and performance when applying for subsequent posts

Information for Heads of Firms/Units

-s the Training Supervisor, you are required to review the registrar2s documentation of clinical and procedural experience obtained in your "irm#$nit )onfirm that it is correct by signing in the spaces provided - brief comment may be added if necessary -lso ensure that you have completed the )ontinuous -ssessment "orm at the end of the registrar2s rotation

To the Programme Supervisor / Head of Department

This portfolio helps to support you in executing your responsibilities as the overall Programme Supervisor Please complete the Programme Supervisor2s -nnual /eview form and advise the registrar of any deficiencies or problems Please note you are required to sign all cumulative records at the end of the training period 3ote also the requirement that the candidate become proficient in the performance of procedures generally performed by a specialist dermatologist The minimum number of procedures recommended is indicated on the relevant pages of the Procedures Section of the portfolio

SECTION $ P2!S10(- &2.(I-S

PERSONAL DETAILS Surname: Start *ate: -ddress: 4mail: 5asic 0edical *egree: 6ther 7ualification: )ompletion of ") *erm&S-' Part ! &mm#yy': PREVIOUS EXPERIE !E !nternship: %ospital 8 9ocation *epartments *ates Tel: $niversity: $niversity: )ell: (ear: (ear: /eg post no : "irst 3ame: %P)S- Training 3o:

Post-!nternship -ctivities: Status %ospital 8 9ocation *epartments *ates

)ourses#)ongresses -ttended:

SECTION % P!13!(,,2 S4P2!5IS1! S (004(- !25I2/

S : Satisfactory $#S : $nsatisfactory

"ear # /otations Procedures /esearch Pro;ect -cademic Presentations Teaching -ctivities )ontinuous -ssessments !omments "ear #

"ear $

"ear %

"ear &

Programme Supervisor: &Print 3ame' !omments "ear $ &Signature'

Programme Supervisor: &Print 3ame' !omments "ear % &Signature'

Programme Supervisor: &Print 3ame' !omments "ear & &Signature'

Programme Supervisor: &Print 3ame' &Signature'

SECTION & !2P1!.S 10 !1.(.I10S

SU''(R" OF EXPERIE !E DURI ) ROT(TIO 9og for the period starting Supervisor: Provide a brief description of your duties, patient profile and patient numbers personally managed, and give a brief reflection of your experience of this rotation *etails of academic presentations, research 8 teaching activities, and periods of leave should be recorded in the relevant sections of the portfolio -s. your Training Supervisor to review the information and add a brief comment and ending

Training Supervisor<s )omments:

/egistrar: &Print name' Training Supervisor: &Print name' *ate: &Signature' &Signature'

9eave:

SECTION ' "4,4-(.I52 !2"1!&S 1F !1.(.I10S

C/M/LATI0E RECORD OF ROTATIONS Start a12 E12 Dates of Rotatio1 No of Mo1ths Name of /1it3Firm

!egistrar6 'Print 0ame) Programme Supervisor6 'Print 0ame) &ate6 'Signature) 'Signature)

SECTION ( "10.I0414S (SS2SS,20.S

!O TI UOUS (SSESS'E T FOR' /otation: %ospital and $nit: *ate of commencement of /egistrarship: 'ar*ing s+a,e- =>+? : excellent; @>A : above average; B>C : average#satisfactory; D>E : below average#unsatisfactory; +>, : very wea.; 3#- : not applicable or don<t .now Score + > +? . O/0ED)E 5asic sciences )linical *ermatology Fnowledge of dermatological literature )ontributions to academic meetings S.I00S )linical competence 4ffective communication Technical # procedural s.ills *ocumentation: case notes, letters, summaries 7uality of nurse and student supervision Student and nurse teaching 9eadership # organiGational s.ills PROFESSIO (0 V(0UES ( D (TTITUDES 7uality of patient care /esponsibility # reliability )ommitment !nterpersonal and health care team relationships )oping under stress OVER(00 (SSESS'E T Hlobal rating )omments: Period under review:

Supervisor<s name: Supervisor<s signature: *ate:

/egistrar<s signature:

*ate:

SECTION ) P!1"2&4!2S
PRO!EDURE TOT(0S )omplete this summary page only at the end of your E-year training period ame of pro+edure )ryotherapy )urettage benign lesions )urettage malignant lesions Punch 5iopsies 4lliptical excision benign lesion 4lliptical excision malignant lesion Shave excisions !ntralesional in;ections P$I- Treatments $I5 Treatments S.in Patch Tests F6% Scrapings: "ungi F6% Scrapings: Scabies TGanc. preparations # microscopy *ermoscopy performed 6thers Tota, num1er performed

/egistrar: &Print 3ame' Programme Supervisor: &Print 3ame' *ate: &Signature'

&Signature'

!R"OTHER(P" 2'inimum 34 Patient name and um1er Date Supervisor5s Signature

!URETT()E 6E I) 0ESIO S 2'inimum 34 Patient ame 7 o8 Date Supervisor5s Signature

!URETT()E '(0I) ( T 0ESIO S 2minimum 9 34

Patient ame 7 o8

Date

Supervisor5s Signature

PU !H 6IOPSIES 2minimum 9 34 Patient ame 7 o8 Date Supervisor5s Signature

E00IPTI!(0 EX!ISIO 6E I) 0ESIO 2'inimum 34

Patient ame 7 o8

Date

Supervisor5s Signature

E00IPTI!(0 EX!ISIO '(0I) ( T 0ESIO 2'inimum 34 Patient ame 7 o8 Date Supervisor5s Signature

SH(VE EX!ISIO S 2'inimum 34 Patient ame 7 o8 Date Supervisor5s Signature

PUV( TRE(T'E TS 2minimum 9 #:4 Patient ame 7 o8 Date Supervisor5s Signature

I TR(0ESIO (0 I ;E!TIO S 2minimum 9 34 Patient ame 7 o8 Date Supervisor5s Signature

UV6 TRE(T'E TS 2minimum 9 34 Patient ame 7 o8 Date Supervisor5s Signature

S.I P(T!H TESTS 2minimum 9 #34 Patient ame 7 o8 Date Supervisor5s Signature

.OH S!R(PI )S- FU )I 2minimum 34 Patient ame 7 o8 Date Supervisor5s Signature

.OH S!R(PI )S- S!(6IES 2'inimum %4 Patient ame 7 o8 Date Supervisor5s Signature

T<( !. PREP(R(TIO S 2'inimum 34 Patient ame 7 o8 Date Supervisor5s Signature

DER'OS!OP" PERFOR'ED 2'inimum 34 Patient ame 7 o8 Date Supervisor5s Signature

OTHER / (DDITIO (0 PRO!EDURES Patient ame 7 o8 Date Supervisor5s Signature

SECTION * !2S2(!"7 P!1J2".S$ ("(&2,I" P!2S20.(.I10S$ (0& .2("7I03 (".I5I.I2S

TR(I I ) I RESE(R!H 'ETHODO0O)" Dates Detai,s

RESE(R!H PRO;E!T Topic:

Supervisor: *ate of Protocol Submission: *ate of "inal Pro;ect Submission: *ate of "inal -pproval: *ate, forum and title of presentations related to your research pro;ect: Protocol -pproved: &tic.'

/egistrar: &Print 3ame' Programme Supervisor: &Print 3ame' *ate: (!(DE'I! PRESE T(TIO S Date Forum Topi+ Supervisor5s Signature &Signature' &Signature'

/egistrar: &Print 3ame' Programme Supervisor: &Print 3ame' *ate: &Signature'

&Signature'

SECTION + !2"1!& 1F -2(52 .(820

RE!ORD OF 0E(VE T(.E Specify whether vacation, study, sic. leave, maternity, etc Start 7 End Dates o8 =or*ing da>s T>pe of 0eave !omments

/egistrar: &Print 3ame' Programme Supervisor: &Print 3ame' *ate: &Signature'

&Signature'

SECTION #, &2"-(!(.I10 10 "1,P-2.I10 1F .!(I0I03

!, and training from hereby declare that all information to

contained in this Portfolio is a true and accurate record of my professional experience, education representing the period of training for the ") *erm &S-' qualification

Signature of /egistrar: 3ame of /egistrar: %P)S- 3umber: *ate: