personal information

Name ............................................................................................................

Date of birth           /               /

Date of entry into Specialist Paediatric Surgical Training              /              /

Anticipated date of completion of Specialist Paediatric Surgical Training      /       /

Centre ......................................................................................

type

A. NEONATAL SURGERY

1

2

3

4

5

total

A.1

oesophageal atresia

A.2

duodenal atresia

A.3

malrotation/volvolus

A.4

meconium peritonitis

A.5

necrotizing enterocolitis

A.6

intestinal atresia

A.7

Hirschsprung's disease

A.8

anorectal malformations

A.9

gastrostomy, ileostomy, colostomy

A.10

inguinal hernia

A.11

central venous lines

A.12

hydrocephalus

A.13

spina bifida

A.14

thoracotomy

A.15

congenital diaphragmatic hernia

A.16

lobectomy, pneumonectomy

A.17

exomphalos

A.18

gastroschisis

A.19

exstrophy

A.20

nephrectomy

A.21

partial nephrectomy

A.22

nephrostomy

A.23

torsion of testis

A.24

orchidectomy

A.25

posterior urethral valves

A.26

others

B. EMERGENCY SURGERY

1

2

3

4

5

total

B.1

tracheostomy

B.2

soft tissue trauma

B.3

insertion of drains

B.4

burns

B.5

skin grafting

B.6

thoracic emergency surgery

B.7

abdominal emergency surgery

B.8

renal,genitourinary emergency surgery

B.9

insertion-revision of shunts (VA,VP)

B.10

drainage of abscesses

B.11

appendectomy

B.12

peritonitis

B.13

intussusception

B.14

intestinal obstruction

B.15

intestinal resection

B.16

ileostomy, colostomy

B.17

laparoscopy

B.18

others

C. GENERAL PEDIATRIC SURGERY

1

2

3

4

5

total

1. day case surgery

C.1.1

inguinal hernia

C.1.2

umbilical hernia

C.1.3

epigastric hernia

C.1.4

hydrocele

C.1.5

undescended testis

C.1.6

circumcision

C.1.7

biopsy

C.1.8

hypospadias (minor)

C.1.9

I.G. nail

C.1.10

ganglion, bursa

C.1.11

others

2. Gastrointestinal surgery

1

2

3

4

5

total

C.2.1

endoscopy

C.2.2

fundoplication

C.2.3

gastrostomy, ileostomy, colostomy

C.2.4

pyloric stenosis

C.2.5

biliary atresia

C.2.6

cholecistectomy

C.2.7

splenectomy

C.2.8

Hirschsprung' s disease

C.2.9

others

3. head and neck surgery

1

2

3

4

5

total

C.3.1

central venous line

C.3.2

dermoid cyst

C.3.3

branchial remnants

C.3.4

torticollis

C.3.5

thyroglossal cyst

C.3.6

thyroid

C.3.7

cystic hygroma

C.3.8

nodes

C.3.9

parotid - salivary glands

C.3.10

others

4. Urology

1

2

3

4

5

total

C.4.1

circumcision

C.4.2

orchidopexy

C.4.3

hypospadias repair

C.4.4

cystoscopy

C.4.5

nephrectomy

C.4.6

partial nephrectomy

C.4.7

posterior urethral valves

C.4.8

pyeloplasty

C.4.9

anti-reflux procedures

C.4.10

bladder augmentation

C.4.11

lithiasis

C.4.12

urinary diversion

C.4.13

urinary un-diversion

C.4.14

others

5. Thoracic surgery

1

2

3

4

5

total

C.5.1

bronchoscopy

C.5.2

oesophageal atresia

C.5.3

oesophagoscopy

C.5.4

oesophageal resection

C.5.5

oesophageal replacement

C.5.6

pleural drainage

C.5.7

pulmonary resection

C.5.8

thoracotomy for duplication cyst

C.5.9

thoracotomy for tumour

C.5.10

others

6. Tumour Surgery

1

2

3

4

5

total

benign

C.6.1

teratoma

C.6.2

ovarian cyst

C.6.3

lymphangioma

C.6.4

haemangioma

C.6.5

fibromatosis

C.6.6

ganglioneuroma

C.6.7

congenital mesoblastic nephroma

malignant

C.6.8

Wilms' tumour, nephroblastoma

C.6.9

neuroblastoma

C.6.10

rhabdomyosarcoma

C.6.11

teratoma

C.6.12

others

date

Hosp.#

dob

Diagnosis

Operation

Type

Audit

comments

dates

Name of meeting

participation

Organization certificate

List of Scientific presentations, Publications and Works

Presentations at Scientific Meetings

Publications and Works (Title, Authors and source)

Unpublished Works awaiting Publication (Title and Authors)

Thesis (Title, abstract and date of completion)