Mid-Cycle Review

Section 1 - Your details

Health Service(Required)

Name of person completing the response:(Required)

Prefix First Last

Role(Required)

Email(Required)

What was the date range for your last survey visit?

Start Date(Required)

End Date(Required)

Section 2 - Prevocational Education and Assessment

Please upload the following based on your prevocational program:

• PGY1 and/or PGY2 Education schedule with topics

• PGY1 attendance at Intern training for the current clinical year as a percentage per session

• PGY1 and/or PGY2 record of % of mid and end of term assessments completed for the current clinical year.

PGY1 Education Program(Required)

Drop files here or

Max. file size: 5 MB.

PGY1 Attendance Register(Required)

Drop files here or

Max. file size: 5 MB.

PGY1 Assessment Record(Required)

Drop files here or

Max. file size: 5 MB.

PGY2 Education Program

Drop files here or

Max. file size: 5 MB.

PGY2 Assessment Record(Required)

Drop files here or

Max. file size: 5 MB.

Section 3 - Planned Posts

Is your health service planning to increase or decrease posts prior to your next survey visit?(Required)

Increase

Decrease

Please list the posts(Required)

eg Intern, General Surgery, 1 EFT

Level

Stream

EFT

Section 4 - Proposed Initiatives and Identified Issues

Please provide comment on any new developments and initiatives expected prior to the next survey visit which may impact Intern and/or PGY2 training. *

Please provide comment on any new issues identified or expected prior to the next survey visit which may have an impact on Intern and/or PGY2 training. *

Section 5 - Monitoring Action Plan

Please complete the update column in the provided spreadsheet for all conditions and recommendations prior to uploading and submitting to PMCV for review

Template upload(Required)

Drop files here or

Max. file size: 5 MB.

Section 6 - Supporting Evidence

Please attach all supporting evidence below.

Supporting evidence

Drop files here or

Max. file size: 100 MB.

Additional comments

Section 7 - Declaration

This declaration must be completed by the CMO/DMS or your health service. If you are not the CMO/DMS please save this form using "Save and Continue later" and email the CMO/DMS the link to complete.

Name(Required)

Prefix First Last

Email(Required)

Date(Required)

Declaration(Required)

• PMCV Clinical Learning for Junior Doctors Guidelines
• PMCV Clinical Supervision of Junior Doctors Guidelines
• PMCV Performance Assessment and Feedback Guidelines for Junior Doctors

I declare the information contained in this application is correct at the time of submission and this post complies with the above guidelines.

Accreditation guidelines can be found here: Accreditation Resources

Mid-Cycle Review

Mid-Cycle Review

Section 1 - Your details

What was the date range for your last survey visit?

Section 2 - Prevocational Education and Assessment

Section 3 - Planned Posts

Section 4 - Proposed Initiatives and Identified Issues

Section 5 - Monitoring Action Plan

Section 6 - Supporting Evidence

Section 7 - Declaration

Collaboration