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MSF August 2014

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mosalaith
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10 views

MSF August 2014

Uploaded by

mosalaith
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Multi-Source Feedback

Trainee’s Name:
Trainee’s GMC Number:
Trainee’s Year:
Assessor’s Name:
Assessor’s Email Address:
Assessor’s Registration Number (e.g. GMC, NMC, GDC):
Assessor’s position: Consultant SAS SpR SHO GP Nurse Other
If Other, please specify:
How do you rate this Doctor in their:
Well below Below Borderline for Meets Above Well above Unable to
expectations expectations stage of expectations expectations expectations comment*
for stage of for stage of training for stage of for stage of for stage of
training training training training training
Communication skills: Communicates effectively with patients and families:
☐ ☐ ☐ ☐ ☐ ☐ ☐
Comments:

Communication skills: Communicates effectively with healthcare professionals:


☐ ☐ ☐ ☐ ☐ ☐ ☐
Comments:

Attitude to patients: Respects the rights, choices, beliefs and confidentiality of patients:
☐ ☐ ☐ ☐ ☐ ☐ ☐
Comments:

Attitude to staff: Respects and values contributions of other members of the team:
☐ ☐ ☐ ☐ ☐ ☐ ☐
Comments:

Well below Below Borderline for Meets Above Well above Unable to
expectations expectations stage of expectations expectations expectations comment*
for stage of for stage of training for stage of for stage of for stage of
training training training training training
Team player skills: Supportive and accepts appropriate responsibility; Approachable:
☐ ☐ ☐ ☐ ☐ ☐ ☐
Comments:

Reliability and Punctuality:


☐ ☐ ☐ ☐ ☐ ☐ ☐
Comments:

Leadership skills: Takes responsibility for own actions and actions of the team:
☐ ☐ ☐ ☐ ☐ ☐ ☐
Comments:

OVERALL PROFESSIONAL COMPETENCE:


☐ ☐ ☐ ☐ ☐ ☐ ☐
*Unable to comment: Please mark this is you have not observed the behaviour and therefore feel unable to comment
Honesty and Integrity, do you have any concerns? Yes No
If yes please state your concerns:

Anything especially good?

Please describe any behaviour that has raised concerns or should be a particular focus for development:

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