This document is a structured reference form for applicants to intercollegiate examinations. It requires referees to confirm the applicant's diagnostic, clinical, technical and professional skills as well as communication abilities. Referees must declare that the applicant has appropriate experience and training to sit the examination.
This document is a structured reference form for applicants to intercollegiate examinations. It requires referees to confirm the applicant's diagnostic, clinical, technical and professional skills as well as communication abilities. Referees must declare that the applicant has appropriate experience and training to sit the examination.
This document is a structured reference form for applicants to intercollegiate examinations. It requires referees to confirm the applicant's diagnostic, clinical, technical and professional skills as well as communication abilities. Referees must declare that the applicant has appropriate experience and training to sit the examination.
This document is a structured reference form for applicants to intercollegiate examinations. It requires referees to confirm the applicant's diagnostic, clinical, technical and professional skills as well as communication abilities. Referees must declare that the applicant has appropriate experience and training to sit the examination.
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Joint Committee on Intercollegiate Examinations
Structured Reference Form
(to be read in conjunction with Guidance Notes for Referees and examination Regulations) This form should be used for new applications for examinations taking place up to 30 September 2023 Section A – to be completed by Applicant Specialty Examination Date Examination Closing Date for Applications Applicant’s Last Name Other Names in full Home Address
Postcode GMC/IMC Number Date of Birth (day/month/year)
Sections B – H inclusive – to be completed by Referee
Guidance for Referees UK & Republic of Ireland Trainees: • The Training Programme Director (i.e. Principal Referee) confirms that the applicant has acquired the applied knowledge and clinical skills to be assessed at the level of a Day 1 Consultant in the generality of the Specialty • The applicant must satisfy one of the following criteria: o Completion of Phase 2 of the relevant specialty curriculum with an ARCP Outcome 1 o Be a maximum of 2 WTE clinical years in advance of the indicative CCT/CCST date and have an ARCP Outcome 1 at that point in training If the applicant is not on a training programme then you must be satisfied that the applicant has equivalent experience at the level stated above for UK and Republic of Ireland trainees and has had specific training in the areas of surgical practice which will be examined in the Section 2 component of the examination and satisfies all the criteria as defined in the Guidance Notes for Applicants. The applicant has, in the last 4 years, undertaken appropriate training in those areas of surgical practice that will be examined in the Section 2 component of the examination. The applicant regularly attends the Higher Surgical Training Programme and/or has attended appropriate training courses and has knowledge of the literature relevant to the specialty. Information on poorly performing candidates will be fed back to referees. Signing up an applicant who does not meet the above criteria and whose performance in the examination is excessively poor could be perceived as a potential probity issue for the referee with regard to patient safety.
Section B Referee’s Name Position GMC/IMC Number Hospital Address
Post Code Telephone Mobile E-mail
Joint Committee on Intercollegiate Examinations
Policy No. OP11 v4.0 Date of last review: Aug 2022 Please tick relevant box(s) Programme Director Clinical/Medical Director Consultant Trainer Head of Department Supervising Consultant Senior Colleague on UK/Irish Medical Register Chairman/Member Regional Training Committee My detailed comments on the above applicant’s suitability to take this examination are as follows:
Section C – Diagnostic Skills [See accompanying Guidance Notes on Diagnostic Skills]
Section D – Clinical Management [See accompanying Guidance Notes on Clinical Management]
Section E – Technical Operative Skills [See accompanying Guidance Notes on Technical Operative Skills]
Section F – Professionalism & Probity [See accompanying Guidance Notes on Professionalism]
Section G – Communication & Language Skills [See accompanying Guidance Notes on Communication & Language Skills] Declaration
I declare that: please
1. I confirm that my name appears on the UK or Irish Medical Register
2. I confirm that I have read and understood the standards set out in the Guidance Notes for Referees and the relevant general and specialty-specific standards set out in the Intercollegiate Surgical Curriculum for the award of the Certificate of Completion of Training (CCT) by the GMC or the award of Certificate of Completion of Specialist Training (CCST) by the Royal College of Surgeons in Ireland and have completed this structured report with reference to those standards.
3. I confirm that I have direct knowledge of the applicant’s current clinical practice within the last 2 years [applicable to all referees except Training Programme Directors].
4. I confirm that I am the applicant’s Training Programme Director and confirm that: • the applicant has acquired the applied knowledge and clinical skills to be assessed at the level of a Day 1 Consultant in the generality of the Specialty • The applicant satisfies one of the following criteria: o Has completed Phase 2 of the relevant specialty curriculum with an ARCP Outcome 1 o Is a maximum of 2 WTE clinical years in advance of the indicative CCT/CCST date and has an ARCP Outcome 1 at that point in training [applicable to Training Programme Directors only]
5. I confirm that I have examined the applicant’s portfolio including logbook and summary of operative experience and that this is commensurate with a UK or Ireland trainee within 2 years of CCT or CCST respectively.
6. I accept that I have a responsibility to the profession and confirm that the information contained in this reference is true and accurate and referenced to Good Medical Practice.
7. I confirm that, to the best of my knowledge, the information I have given in this structured reference is true and accurate. I understand that it will be used by the Intercollegiate Specialty Board in its evaluation of this doctor’s application for entry to the Intercollegiate Specialty Examination.
Section H
I confirm that I am , the sponsoring referee named above and have no reservations about this candidate’s application for entry to the examination.
