Online Pathway

This application form can be used for all pathways and procedure types. Blank spreadsheets for generating KPIs from data extracted from ProVation and SOLA, ANZ Conjoint DOPS and the blank cleaning log are available under the information and forms tab.

Paper logbooks will continue to be accepted for trainees who commenced prior to 2021.

Online Application Form for Recognition of Training in Endoscopy

Personal Details

Name is required
Phone is required
Email is required
Pathway is required

Training and Procedures

Training Scheme is required
Training dates from is required
Training dates to is required
Provide details with the following format (1 per line): Date from, Date to, Hospital, Supervisor
Training hospitals and supervisors is required
Hospital is required
Years of endoscopy practice from is required
Years of endoscopy practice to is required
NZ Vocational Scope type is required
NZ Vocational Scope year of qualification is required
Type of procedures is required

Gastroscopy Section

Adult/Paediatric is required
Total Number is required
D2 intubation rate is required
Provide details in this space to clarify the interventional procedures that you have undertaken, particularly if these are not clear from your log. If you are including haemostatic procedures in the colon for this requirement please list these with the following format : Date, Patient age, Patient gender, Hospital, Type of procedure, Supervisor. You may be asked to provide further evidence (e.g. endoscopy reports) to support this information.
Interventional Procedures is required
Accepted file types: png, jpg, jpeg, docx, xlsx, pdf. Max file size: 5MB
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Upload gastroscopy logbook/spreadsheet is required
Accepted file types: png, jpg, jpeg, docx, xlsx, pdf. Max file size: 5MB
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Upload gastroscopy DOPS files is required

Referee 1

Name is required
Email is required
Hospital is required
Number of Gastroscopies supervised is required

Referee 2

Name is required
Email is required
Hospital is required
Number of Gastroscopies supervised is required

Colonoscopy Section

Adult/Paediatric is required
Total Number is required
CCR rate (for final 50) is required
TI intubation rate (for final 50) is required
Provide details in this space to clarify the advanced polypectomies that you have undertaken, particularly if these are not clear from your log. If listing individual procedures please include Date, Patient age, Patient gender, Hospital, Type of polypectomy, Supervisor. You may be asked to provide further evidence (e.g. endoscopy reports) to support this information.
Advanced polypectomy is required
Accepted file types: png, jpg, jpeg, docx, xlsx, pdf. Max file size: 5MB
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Upload colonoscopy logbook/spreadsheet is required
Accepted file types: png, jpg, jpeg, docx, xlsx, pdf. Max file size: 5MB
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Upload colonoscopy DOPS files is required

Referee 1

Name is required
Email is required
Hospital is required
Number of Colonoscopies supervised is required

Referee 2

Name is required
Email is required
Hospital is required
Number of Colonoscopies supervised is required

ERCP Section

Total Number is required
Target duct cannulation rate (for final 50) is required
Number of unassisted sphincterotomies is required
Provide details with the following format (1 per line): Type(Biliary - plastic, Biliary - metal, Pancreatic), Number change to List the number of stents placed by type - Biliary - plastic, biliary - metal and pancreatic.
Stents is required
Accepted file types: png, jpg, jpeg, docx, xlsx, pdf. Max file size: 5MB
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Upload ERCP logbook/spreadsheet is required
Accepted file types: png, jpg, jpeg, docx, xlsx, pdf. Max file size: 5MB
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Referee 1

Name is required
Email is required
Hospital is required
Number of ERCPs supervised is required

Referee 2

Name is required
Email is required
Hospital is required
Number of ERCPs supervised is required

Supporting Documents

Accepted file types: png, jpg, jpeg, docx, xlsx, pdf. Max file size: 5MB
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Upload supporting information on international training is required
Accepted file types: png, jpg, jpeg, docx, xlsx, pdf. Max file size: 5MB
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Upload safe sedation training certificate is required
Accepted file types: png, jpg, jpeg, docx, xlsx, pdf. Max file size: 5MB
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Upload scope cleaning log is required
Accepted file types: png, jpg, jpeg, docx, xlsx, pdf. Max file size: 5MB
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Upload logbook/spreadsheet is required
Accepted file types: png, jpg, jpeg, docx, xlsx, pdf. Max file size: 5MB
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Upload DOPS is required
Accepted file types: png, jpg, jpeg, docx, xlsx, pdf. Max file size: 5MB
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Upload EUG affidavit is required

Referee 1

Name is required
Email is required
Hospital is required
Number of procedures supervised is required

Referee 2

Name is required
Email is required
Hospital is required
Number of procedures supervised is required

Declaration

Declaration – I confirm that the information provided in this application is accurate and complete and that I am aware that concerns about data manipulation (fraud) may be referred to the New Zealand Medical Council or other Professional body.

My referees are aware that they need to send confidential reports on my performance directly via the online referee form.

Declaration – I confirm that the information provided in this application is accurate and complete and that I am aware that concerns about data manipulation (fraud) may be referred to the New Zealand Medical Council or other Professional body.

Declaration – I confirm that the information provided in this application is accurate and complete and that I am aware that concerns about data manipulation (fraud) may be referred to the New Zealand Medical Council or other Professional body.

My New Zealand referees are aware that they need to send confidential reports on my performance directly, and my International referees are aware that they may be contacted.

I confirm that I intend to practice endoscopy in New Zealand in the long term (at least twelve months)