1

Assessments and appraisals

Qualifications
Domain 1 Knowledge, skills and performance
The list below shows all the types of evidence in the category of qualifications that are relevant
to your specialty.
Please click View/Edit for each item on the list and record the details of the evidence you want to
provide.
If you have no evidence for a particular item on the list, please click View/Edit and check the
appropriate box to mark the item as complete.
You will not be able to submit your application until each item is marked complete.

Evidence Item Completed View/Edit
Primary medical qualification (PMQ)

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Specialist medical qualification(s)

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Curriculum or syllabus (if undertaken outside the UK)

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Specialist registration outside the UK

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Honours and prizes

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Other relevant qualifications and certificates

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Primary medical qualification (PMQ)

Specialist medical qualification(s)

Curriculum or syllabus (if undertaken
outside the UK)

Specialist registration outside the UK

Honours and prizes

Other relevant qualifications and
certificates

Assessments and appraisals
Domain 1 Knowledge, skills and performance
The list below shows all the types of evidence in the category of assessments and
appraisals that are relevant to your specialty.
Please click View/Edit for each item on the list and record the details of the evidence you want to
provide.
If you have no evidence for a particular item on the list, please click View/Edit and check the
appropriate box to mark the item as complete.
You will not be able to submit your application until each item is marked complete.

Evidence Item Completed View/Edit
Appraisals and assessments

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Records of In Training Assessment (RITAs), Annual Review of
Competency Progress (ARCPs) and other training assessments

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2

360 and multi-source feedback

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Awards and discretionary points letters

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Personal development plans (PDP)

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Participation in assessment, appraisal and appointments process

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Appraisals and assessments
Records of In Training Assessment
(RITAs), Annual Review of Competency
Progress (ARCPs) and other training
assessments

360 and multi-source feedback
Awards and discretionary points letters
Personal development plans (PDP)
Participation in assessment, appraisal
and appointments process




Logbooks
Domain 1 Knowledge, skills and performance
The list below shows all the types of evidence in the category of logbooks that are relevant to your
specialty.
Please click View/Edit for each item on the list and record the details of the evidence you want to
provide.
If you have no evidence for a particular item on the list, please click View/Edit and check the
appropriate box to mark the item as complete.
You will not be able to submit your application until each item is marked complete.

Evidence Item Completed View/Edit
Logbooks

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Consolidation, cumulative data sheets, summary lists and annual caseload
statistics

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Medical reports

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Case histories

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Referral letters discussing patient handling

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Patient lists

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Departmental (or trust) workload and annual caseload statistics

View/Edit
3

Rotas, timetables and job plans

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Courses relevant to curriculum

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Portfolios (electronic or revalidation)

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Logbooks
Consolidation, cumulative data sheets,
summary lists and annual caseload
statistics

Medical reports
Case histories
Referral letters discussing patient handling
Patient lists
Departmental (or trust) workload and
annual caseload statistics

Rotas, timetables and job plans
Courses relevant to curriculum
Portfolios (electronic or revalidation)


Details of posts and duties
Domain 1 Knowledge, skills and performance
The list below shows all the types of evidence in the category of details of posts and duties that
are relevant to your specialty.
Please click View/Edit for each item on the list and record the details of the evidence you want to
provide.
If you have no evidence for a particular item on the list, please click View/Edit and check the
appropriate box to mark the item as complete.
You will not be able to submit your application until each item is marked complete.

Evidence Item Completed View/Edit
Employment letters and contracts of employment

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Job descriptions

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Job plans

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Employment letters and contracts of
employment

Job descriptions

Job plans

Research, publications and presentations
4

Domain 1 Knowledge, skills and performance
The list below shows all the types of evidence in the category of research, publications and
presentations that are relevant to your specialty.
Please click View/Edit for each item on the list and record the details of the evidence you want to
provide.
If you have no evidence for a particular item on the list, please click View/Edit and check the
appropriate box to mark the item as complete.
You will not be able to submit your application until each item is marked complete.

Evidence Item Completed View/Edit
Research papers, grants

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Publications within specialty field

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Presentations

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Research papers, grants

Publications within specialty field

Presentations


CPD and CME
Domain 1 Knowledge, skills and performance
The list below shows all the types of evidence in the category of continuing professional
development and continuing medical education that are relevant to your specialty.
Please click View/Edit for each item on the list and record the details of the evidence you want to
provide.
If you have no evidence for a particular item on the list, please click View/Edit and check the
appropriate box to mark the item as complete.
You will not be able to submit your application until each item is marked complete.

Evidence Item Completed View/Edit
CPD record certificates and certificates of attendance

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CPD registration points

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Membership of professional bodies

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CPD record certificates and certificates of
attendance

CPD registration points
Membership of professional bodies

Teaching and training
5

Domain 1 Knowledge, skills and performance
The list below shows all the types of evidence in the category of teaching and training that are
relevant to your specialty.
Please click View/Edit for each item on the list and record the details of the evidence you want to
provide.
If you have no evidence for a particular item on the list, please click View/Edit and check the
appropriate box to mark the item as complete.
You will not be able to submit your application until each item is marked complete.

Evidence Item Completed View/Edit
Teaching timetables

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Lectures

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Feedback or evaluation forms from those taught

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Letters from colleagues

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Attendance at teaching or appraisal courses

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Participation in assessment, appraisal and appointments processes

View/Edit

Teaching timetables

Lectures

Feedback or evaluation forms from
those taught

Letters from colleagues

Attendance at teaching or appraisal
courses

Participation in assessment, appraisal
and appointments processes



Participation in audit
Domain 2 Safety and quality
The list below shows all the types of evidence in the category of participation in audit that are
relevant to your specialty.
Please click View/Edit for each item on the list and record the details of the evidence you want to
provide.
If you have no evidence for a particular item on the list, please click View/Edit and check the
appropriate box to mark the item as complete.
You will not be able to submit your application until each item is marked complete.

Evidence Item Completed View/Edit
Audits undertaken by applicant

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Reflective diaries

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Service Improvement and clinical governance meetings

View/Edit


6

Audits undertaken by applicant


Reflective diaries

Service Improvement and clinical governance
meetings


Safety
Domain 2 Safety and quality
The list below shows all the types of evidence in the category of safety that are relevant to your
specialty.
Please click View/Edit for each item on the list and record the details of the evidence you want to
provide.
If you have no evidence for a particular item on the list, please click View/Edit and check the
appropriate box to mark the item as complete.
You will not be able to submit your application until each item is marked complete.

Evidence Item Completed View/Edit
Health and safety

View/Edit

Health and safety


Communication
Domain 3 Communication, partnership and teamwork
The list below shows all the types of evidence in the category of communication that are relevant
to your specialty.
Please click View/Edit for each item on the list and record the details of the evidence you want to
provide.
If you have no evidence for a particular item on the list, please click View/Edit and check the
appropriate box to mark the item as complete.
You will not be able to submit your application until each item is marked complete.

Evidence Item Completed View/Edit
Colleagues

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Patients

View/Edit


Colleagues

Patients

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Partnership and teamwork
Domain 3 Communication, partnership and teamwork
The list below shows all the types of evidence in the category of partnership and teamwork that
are relevant to your specialty.
Please click View/Edit for each item on the list and record the details of the evidence you want to
provide.
If you have no evidence for a particular item on the list, please click View/Edit and check the
appropriate box to mark the item as complete.
You will not be able to submit your application until each item is marked complete.

Evidence Item Completed View/Edit
Working in multidisciplinary teams

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Management and leadership experience

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Chairing meetings and leading projects

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Working in multidisciplinary teams

Management and leadership experience

Chairing meetings and leading projects

Acting with honesty and integrity
Domain 4 Maintaining trust
The list below shows all the types of evidence in the category of acting with honesty and
integrity that are relevant to your specialty.
Please click View/Edit for each item on the list and record the details of the evidence you want to
provide.
If you have no evidence for a particular item on the list, please click View/Edit and check the
appropriate box to mark the item as complete.
You will not be able to submit your application until each item is marked complete.

Evidence Item Completed View/Edit
Honesty and integrity

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Equality and human rights

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Data protection

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Honesty and integrity

8

Equality and human rights

Data protection

Relationships with patients
Domain 4 Maintaining trust
The list below shows all the types of evidence in the category of relationships with patients that
are relevant to your specialty.
Please click View/Edit for each item on the list and record the details of the evidence you want to
provide.
If you have no evidence for a particular item on the list, please click View/Edit and check the
appropriate box to mark the item as complete.
You will not be able to submit your application until each item is marked complete.

Evidence Item Completed View/Edit
Testimonials and letters from colleagues

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Thank you letters and cards from colleagues and patients

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Complaints and responses to complaints

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Testimonials and letters from colleagues

Thank you letters and cards from colleagues and
patients

Complaints and responses to complaints