Resident / trainee
		
Supervisor

	1st  year	2nd year	3rd year	4th year	5th year	6th year	Cumulative	Min. number	

SURGERY CASE LOG   
Please refer to Minimal Surgical Case Number Recommendations, www.ecvs.org.
Specify number of procedures as primary surgeon (Prim.) / assistant surgeon (Ass.):
Total      		Prim.								160	
                		Ass.								240	
Directly supervised      Prim									
                               Ass									
Soft tissue 		Prim.								60	
                  		Ass.								90	
Directly supervised     Prim.									
                                    Ass.									
	Gastro-int	GI	Prim.								16	
                    		Ass.								24	
	Uro-genital 	UG	Prim. 								12	
                    		Ass.  								18	
	Abdominal	AB	Prim.								6	
			Ass.								9	
	Head&neck	HN	Prim.								10	
			Ass.								15	
	Thoracic	TC	Prim.           								6	
			Ass.								9	
	Skin/recon	SR	Prim.								10	
                     		Ass.								15	
	Other soft t	OS	Prim.									
			Ass.									
Ortho / neuro		Prim.								60	
			Ass.								90	
Directly supervised      Prim									
                                     Ass									
	Osteosynth	SY	Prim.								20	
			Ass.								30	
	Joint	JS	Prim.								26	
			Ass.								39	
	  Arthrosc	AR	Prim.								12	
			Ass.								18	
	Neurosurg	NE	Prim.								14	
			Ass.								21	
	Other ort/neOO	Prim.									
			Ass.									

ACTIVITY LOG
Weeks total								156	
Weeks supervised clinics								94	
Weeks other rotations 
(Research, manuscript, other  
rotations related to program)									
Weeks anaesthesia								2	
Weeks diagnostic imaging								2	
Weeks pathology								2	
Weeks internal medicine								2	

PRESENTATION LOG**
Specify number of conferences / seminars:
**Only presentations that comply with the requirements laid out in the Training Brochure (Element 12) can be counted towards the minimum number of 5 seminar presentations
Attended									
Presented								5	

PUBLICATIONS                  
List status (P/A/S and date), name of Journal and title of publication with author list as submitted
1st authored major publication			
2nd authored or case report
			
Status: P = Published  A = Accepted for publication  S = Submitted    

COMMENTS

	

SIGNATURES  We confirm the accuracy of this log summary
Resident/trainee	Supervisor 	

Aug.2007
Rev Feb 2010