• Application for Accreditation of a Mohs Surgery Training Position

    This form should be completed by the Supervisor of Training with reference to the Accreditation Standards for Mohs Surgery Training Positions.
  • TRAINING FACILITY DETAILS

  • If yes, please provide details of each satellite facility and how much time is spent at each during the week, e.g. 0.2FTE:

  • CANDIDATE DETAILS

  • STANDARD 1 TRAINING AND EDUCATION

  • 9. Mohs candidate timetable (Attachment 1)

    Please append a weekly timetable for the Mohs candidate at your facility:

    The timetable should include all clinic, surgery sessions, dermatopathology instruction sessions, and educational activities. Each clinic entry should specify the type of clinic and the name of the Clinical Supervisor/s. Insert 'Unsupervised' in lieu of Clinic Supervisor's name or 'Observer', if the candidate will not actively participate in the clinic.

    Please attach multiple weekly tables if the candidate will have a ortnightly or monthly timetable. 

  • STANDARD 2 SUPERVISION AND COORDINATION

  • 25. Name and qualifications of Clinical Supervisors (CS)

  • STANDARD 3 EQUIPMENT AND FACILITIES

  • 34. Will the following equipment be available to the Mohs candidate? 

    Select Yes/No as appropriate

  • STANDARD 4 LEARNING AND WORK ENVIRONMENT

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