Name:

Date:

Educational Supervisor:

Present clinical attachment (name of Consultants/Special interest):

Date commenced:

Date due to rotate:

Check-list for discussion:

v      Previous six months/experience to date for new SpRs

v      Any unmet objectives

v      Plans for next six months

-         clinical

-         courses/learning opportunities

-         progress on case reports

-          research plan

-         audit

-         does all this fit in with long-term objectives?

Objectives agreed:

Agreed by: __________________________________   Supervisor

                   __________________________________   Trainee