Workplace-based Assessment for international medical graduates

Supervisor Booklet

Medical Workforce Branch

Office of the Chief Medical Officer

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Contents

Introduction and welcome 3

Background 4

Selection of candidates 4

Supervision requirements 5

Medical Board of Australia supervision requirements 5

WBA Program supervision requirements 5

Primary supervisor 5

Secondary supervisor 5

Supervisor assessment requirements 6

Self-assessment and learning plan 6

Formative supervisor reports 6

Summative supervisor reports 6

Final supervisor report 7

Passing standards for supervisor reports 7

Providing effective feedback 7

Effective descriptors 8

Feedback on under-performance 8

Additional information and resources 9

Appendix 1: WBA Supervisor’s Agreement 10

Appendix 2: Self-Assessment and Learning Plan 11

Appendix 3: Sample Formative Supervisor’s Report Form 3

Appendix 4: Sample Summative Supervisor’s Report Form 7

Appendix 5: Sample Final Report 11

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Contacts

WBA Program accredited Program Provider management team (Perth Office)

Katrina Lynn WBA Program Manager Honey Donovan Medical Workforce Branch Manager Dr John Keenan Medical Workforce Brach Medical Advisor WBA email: wbawa@health.wa.gov.au WBA phone: 08 9222 4288

WBA Program accredited Health Service Providers (HSPs)

Bunbury Hospital

Judi Gibbs WBA Administrative Officer/Medical Education Officer Dr Perry Travers WBA Program Director

Geraldton Hospital

Christine Golding WBA Administrative Officer/Medical Education Officer Dr Katherine Templeman WBA Program Director

Kalgoorlie Hospital

Kiri Moses WBA Administrative Officer/Medical Education Officer Dr Enasio Morris WBA Program Director

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Introduction and welcome

Welcome to workplace-based assessment (WBA) in Western Australia (WA). Thank you for your willingness to act as a supervisor for international medical graduates (IMGs) undertaking WBA.

The WBA Program in WA commenced as a pilot at Bunbury Hospital in 2010, and has since expanded to Kalgoorlie Hospital (2012) and Geraldton Hospital (2015). It has also been extensively piloted in other states and territories, and currently there are seven accredited program providers and 15 accredited locations across Australia.

The WBA Program provides an opportunity for candidates to be assessed longitudinally by colleagues in regards to clinical competence and knowledge of Australian practices and standards relating to health care delivery.

Assessment is multi-faceted, reflecting a broad scope of clinical activity evaluated by several different methodologies and allowing a comprehensive understanding of the candidate’s skills and knowledge. The feedback loop supports candidates to identify their strengths and development areas to achieve a level of competence equivalent to that of an Australian medical graduate at the end of their intern year.

Your participation in this program is appreciated.

Best wishes

WBA Program management team Medical Workforce Branch, Office of the Chief Medical Officer

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Background

The WBA Program is managed by the Medical Workforce Branch, Office of the Chief Medical Officer, within the Department of Health (the Department).

The AMC requires WBA Programs to be accredited for implementation of assessment against the AMC Workplace-based Assessment Accreditation Guidelines and Procedures, 7 October 2014.

As System Manager, the Department provides overall strategic direction for the WBA program in WA and has been granted accreditation as a Program Provider by the AMC to conduct WBA for IMGs on the standard pathway. There are seven accredited WBA program providers across Australia.

Implementation and day-to-day running of the WBA Program is undertaken by Health Service Providers (HSPs). Nationwide, 15 HSPs are accredited to implement the WBA Program. In WA, the three HSPs currently accredited to implement WBA are Bunbury and Geraldton Hospitals, and the Kalgoorlie Health Campus. Further information: Accredited assessment programs.

WBA provides an alternative mechanism for IMGs to achieve the AMC Certificate and be eligible for general registration with the Medical Board of Australia, assessing on knowledge, clinical skills and professional attributes across the six clinical areas assessed by the AMC Clinical Exam. Candidates are expected to prepare for WBA assessments as they would the AMC Clinical Exam.

The rigour of the WBA assessment provides candidates with the opportunity to modify and improve performance over time; a significant benefit not obtained from the AMC Clinical Examination. Out of 1979 AMC Clinical Examinations held in the 2014/15 financial year, 30% (588) successfully passed; while in the same timeframe nationwide, 76 of 84 IMGs (90%) were successful in achieving the AMC certificate through the WBA Program1.

The WBA Program supports:

Monitored progress through the required supervised pathway,

Identification of, and guidance in addressing, specific learning needs, and

Determination of candidate readiness to proceed to independent (or more independent) practice in Australia.

Educational benefits, including consistency of supervision and assessment techniques within the wider hospital community, have been demonstrated by the WBA Program, including professional development of clinicians performing an assessment role and calibration across all teaching and training interactions.

This Assessor Guide provides the information you will need to support and assess candidates in the WBA program, and introduces the methods of assessment that will be used. Please read all information contained in this Assessor Guide with care. This document may include terminology and concepts that need clarification and you are welcome to discuss any matter covered here with the WBA Program team.

Selection of candidates

IMGs interested in undertaking WBA are encouraged to apply for employment through the annual centralised recruitment process, or other recruitment processes, through MedJobsWA.

Selection to the WBA Program is undertaken in accordance with the WA Health WBA Program Selection and Appointment Guidelines for Hospitals. Candidates must have passed the AMC MCQ exam (i.e. the normal criteria for the AMC Clinical Exam) and have a contract of employment with an HSP accredited for WBA to be eligible.

A candidate who accepts a place in the WBA program cannot apply for the AMC Clinical Exam during the 12 month period of the WBA program. Additionally, if a candidate is already enrolled in the AMC Clinical Exam for the year of WBA commencement, they will need to withdraw to be accepted into the WBA program for that year.

1 Australian Medical Council Annual Report, 2015, Australian Medical Council Limited. Accessed from:

http://www.amc.org.au/publications/annual-reports

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Supervision requirements

Supervisors of IMGs are required to comply with requirements set by the Medical Board of Australia (MBA).

There are additional requirements for IMGs on the WBA Program.

Medical Board of Australia supervision requirements

All candidates in the WBA Program are required to be supervised to address the Medical Board of Australia’s Guidelines: Supervised Practice for International Medical Graduates (4 January 2016) (the guidelines).

The guidelines apply to all types of supervisors including principal supervisor, co-supervisor, term co-supervisor and temporary co-supervisor. They outline the principles of supervision for all supervisors including:

Requirements for types of supervisors

Number of IMGs permitted per supervisor

Temporary supervision arrangements

Supervision levels, and

Reporting requirements

Supervisors must satisfactorily complete the Medical Board of Australia’s (MBA) online education and assessment module to ensure that they understand their roles and responsibilities as a supervisor.

The WBA Program has additional requirements for primary and secondary supervisors.

WBA Program supervision requirements

A supervisor will be assigned to a candidate according to the candidate’s primary place of employment (i.e. ward, clinical area). A candidate may have a primary supervisor and a secondary supervisor.

A supervisor may also be an assessor for other candidates. Further information: WBA Assessor Guide.

The roles of the primary and secondary supervisor are outlined below.

Primary supervisor

Main supervisor providing support to and monitoring of the candidate.

Completes the following documentation:

WBA Supervisor’s Agreement.

Part 2 and Part 5 of the Self-Assessment and Personal Learning Plan.

Completes the following assessment forms:

Supervisor formative and summative reports, including provision of feedback.

Final report for the AMC and MBA.

The primary supervisor is also required to present the collated MSF results to the candidate in a face-to-face meeting.

A WBA Supervisor’s Agreement is provided in Appendix 1.

Secondary supervisor

Assigned to a candidate rotating to an area in which the primary supervisor is not based.

Role while candidate is in this clinical area is to:

Monitor progress and provide support as required e.g. case selection, mentoring.

Prepare formative and summative reports and provide feedback.

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Liaise with the primary supervisor as required.

Supervisor assessment requirements

Supervisors are required to complete various in-training assessments throughout the WBA Program, including a Self-Assessment and Learning Plan, formative and summative supervisor reports and a final supervisor report.

Supervisor reports are available from the indirect assessment web page on the WBA website.

The supervisor report forms (formative and summative) are similar to the Intern training – term assessment form that has been developed by the AMC for interns and is to be completed by the term supervisor and by the intern for mid-term and end of term assessment. Self- assessment is also undertaken.

Self-assessment and learning plan

The self-assessment and personal learning plan provides an opportunity for the candidate and the primary supervisor to identify areas of strength and weakness, and to nominate how learning needs will be addressed.

This is completed in the four week settling in period prior to commencement of assessments.

A self-assessment and learning plan is provided in Appendix 2.

Formative supervisor reports

Supervisor formative reports are completed based on observing the candidate at work or discussing the candidate’s performance with other members of the healthcare team. While these are not required formally for AMC assessment, feedback is valuable as it highlights areas for further development or causes for concern.

The formative report should be seen as a progress report providing candidates with an opportunity to improve performance in preparation for the summative report and enabling familiarisation with an assessment method as well as the clinical skill or dimension.

During the formative report discussion the supervisor and the candidate will identify areas for further learning and development, completing an Improving Performance Action Plan for any borderline or unsatisfactory ratings in the assessment form.

Prior to meeting with the supervisor, the candidate is expected to complete the self-assessment review form so the supervisor can measure the candidate’s awareness of their own strengths and limitations.

The areas of assessment include:

Clinical management.

Communication – including teamwork, and

Professionalism.

Two formative assessments are required to be completed between 18-20 weeks apart, in accordance with the WA Health WBA assessment plan. Further information: WBA Assessor Guide.

Summative supervisor reports

Supervisor reports are completed after observing the candidate’s work and after the supervisor has discussed the candidate’s performance with other members of the healthcare team, including other medical practitioners, nurses, allied health staff and patients.

The summative supervisor report is completed by the supervisor at a meeting with the candidate. The candidate is expected to complete self-assessment review form so the supervisor can measure the candidate’s awareness of their own strengths and limitations.

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The areas of assessment include:

Clinical management.

Communication.

Professionalism.

Honesty, and

Teamwork.

The information in the summative reports contributes to decisions on registration and provides WBA candidates with feedback for their professional development to guide learning.

Candidates must achieve a satisfactory result at an expected level or higher, for both of the summative reports.

Two summative assessments are required to be completed between 18-20 weeks apart, in accordance with the WA Health WBA assessment plan. Further information: WBA Assessor Guide.

Final supervisor report

The final supervisor report provides an overview of the candidate’s progress throughout WBA. Candidates are expected to complete their section of the final report and identify their own strengths and areas for improvement, then arrange a time to meet with their supervisor to discuss progress, review their self-assessment and complete the final report.

The areas of assessment include:

Clinical management.

Communication, including teamwork.

Professionalism, including honesty, and

Safe practice.

The following examples are provided:

A formative supervisor report in Appendix 3.

A summative supervisor report in Appendix 4.

A final supervisor report in Appendix 5.

Passing standards for supervisor reports

Assessment Rating scale Application

Summative supervisor’s report

IPAP Clearly below the level expected Borderline Pass Expected level Clearly above the expected level

All summative supervisors’ reports must achieve a pass score.

If one or more supervisor’s reports indicate that a candidate has not performed to the required PGY1 standard, a review must be held.

Final supervisor’s report

Must achieve either expected level or clearly above the expected level

Prepared by the supervisor for the MBA and the AMC. Summarises progress through WBA.

Providing effective feedback

The provision of immediate and regular feedback is one of the reasons that WBA is successful. Characteristics that have been reported to be possessed by good supervisors include being able to observe and provide constructive, honest feedback.

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Effective feedback will involve a dialogue between the assessor and the candidate, aiming to identify what was done well and not done well, and helping to develop a plan for improvement. In a feedback session, candidates should be challenged to address each of these issues, with the support of the assessor when insight is lacking. Useful feedback requires time, commitment and precision.

Effective descriptors

The AMC identifies that in giving feedback, some words that describe effective feedback are ‘specific’,

‘immediate’, ‘first-hand’, ‘constructive’, ‘descriptive’, ‘action-affirming’ and ‘adequate’. These descriptors

of feedback are outlined as follows:

Specific

The feedback is restricted to the task just performed, and does not include comments that refer

generally to other events.

Immediate

The feedback is provided immediately following, or as soon as practicable after, the observed

performance.

First-hand

The feedback describes what has just been observed by the supervisor/assessor, and does not

include what others might be saying.

Constructive

The feedback provides helpful suggestions for improving performance and/or directs the candidate to

resources that can assist; it serves to motivate and reinforce desirable behaviour.

Descriptive

The feedback describes what was good about the performance, plus what was missing and what

needs to be done to improve; an honest appraisal—which may contain information the candidate

would prefer not to hear—is most appropriately delivered through describing what has just been

observed and specifying the actions/behaviour that were not satisfactory.

Describe behaviours with ‘I’ statements, such as; ‘I observed that…’, ‘This is what I think you did

well….’, ‘These are the areas that I saw need improvement’.

Action-affirming

The feedback sketches out an action plan—which may be recorded on the spot—to give the

candidate a summary of expectations. Encourage self-assessment: ‘How might you try to improve?’

‘Here are some ways you might like to consider.’ Indicate if there are resources that can support

achievement.

Adequate

The feedback is detailed and clear, and ensures that the candidate has understood the message

being given.

Feedback on under-performance

While assessors and candidates would like to see a successful outcome of the assessment process, the

reality is that this will not always be the case. Many assessors find giving feedback to candidates difficult

where candidates are not proceeding through the assessment process as might reasonably be

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expected, or have failed their assessment. The most difficult feedback sessions are those with

individuals who lack insight and fail to reflect on their actions, or have not been successful in their

performance.

It is important that assessors meet their responsibilities in this regard – a poor or failing performance

should be recorded as that.

Additional information and resources

Assessors will need:

Training on giving feedback and handling more difficult cases, prior to their appointment as

assessors;

Clear guidelines on the passing standard and calibration;

The timeline within which assessment must be completed;

Information on opportunities for remediation;

Information on the processes for:

The re-assessment of candidates;

Reporting to appropriate authorities any serious negative outcomes from the assessment

process;

Handling reviews and appeals, with formal processes to handle appeals in a manner that adheres to the principles of procedural fairness.

It will assist candidates in this situation to:

Receive clear, timely and ongoing feedback so that they have had advance warning of their

performance issues;

Have clear information about the assessment processes and processes for appeals.

For the assessment system to be robust and defensible it is important that:

There are fair and transparent processes;

Valid and reliable methods are used, data are appropriately collated, standards are set, results are

defensible and methods are accurate;

Processes are followed for all candidates, without exception;

Well documented and public processes are in place to handle complaints/appeals.

Further information: WbaOnline

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Appendix 1: WBA Supervisor’s Agreement

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Appendix 2: Self-Assessment and Learning Plan

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13

14

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1

2

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Appendix 3: Sample Formative Supervisor’s Report Form

Guiding Principles

This form is to provide information about the performance of candidates at formative report meetings. The information on this form is a mechanism for providing candidates in the WBA Program with feedback on their professional development and to guide learning for the remainder of the term.

The Formative Form is for feedback purposes only. This form will be submitted to the WBA Program Director and will be accessible to the Director of Clinical Training, the Medical Education Officer and the Director of Medical Services. This form must be discussed with the candidate undertaking the WBA program and should include a review of their Self-Assessment Form.

Supervisors are referred to the National Principles of Assessment and Guidelines for Supervisors for assistance in completing this form.

Instructions

Clinical supervisors

1. Must observe the candidate in the workplace prior to assessing.

2. Are encouraged to include observations from multiple sources in developing this assessment e.g. other medical practitioners, nurses, allied health, patients.

3. Are to tick appropriate boxes in the columns provided.

4. Are required to make additional comments where there are ticks in the shaded area and complete the Improving Performance Action Plan (IPAP) overleaf, to commence the remediation process.

Candidate’s Name: __________________________________________________

Position: _________________________________________________

Unit: ____________________________________________________

Hospital: _________________________________________________

Date: ____________________________________

Report number: Report 1 Report 2

Orientation completed: Yes No

Assessment process discussed: Yes No

Specific learning objectives negotiated: Yes No

Please indicate which of the following method/s have been used to inform the completion of this assessment:

Close personal observation

General impressions

Observations made by other team members:

Other e.g. Mini-CEX, DOPS

Please indicate other staff from whom you have sought feedback with regards to the candidate’s performance:

Consultants/s Registrars/s Nursing staff Others, specify ___________________

Workplace Based Assessment

Please list the type and number of Workplace Based Assessments used to inform your assessment of this candidate

Mini-CEX DOPS CBD

4

Clearly below the

level expected

Borderline Expected level

Clearly above

expected level

CLINICAL MANAGEMENT

1. Safe patient care

2. Patient assessment

3. Emergencies

4. Patient management

5. Skills and procedures

COMMUNICATION

6. Patient interaction

7. Managing information

8. Working in teams

PROFESSIONALISM

9. Doctor & society

10. Professional behaviour

11. Teaching and learning

Other Learning Objectives as agreed between the candidate and their Supervisor

12. ________________________________________

13. ________________________________________

14. ________________________________________

Please comment on the following in relation to the candidate’s performance:

1. Strengths

2. Areas for improvement:

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3. Overall performance:

Formative Summative

Clearly below the level expected

Borderline

Expected level

Clearly above expected level

Clearly below the level expected

Borderline

Expected level

Clearly above expected level

Supervisor

Name: __________________________________________ Signature: _______________________________________

Position: ____________________________ Date: _______________________________

Candidate

I (the candidate) confirm that I have had the chance to discuss the above report with my assessor and know I may respond in writing within seven (7) days to the WBA Program Director should I disagree with any points made in this report. Signature: ____________________________________ Date: __________________________

WBA Program Director

Name: __________________________________________ Signature: _______________________________________ Date: ____________________________ Actions:

Reference:

CPMEC Australian Curriculum Framework

Improving Performance Action Plan (IPAP)

This section is used to address identified issues and must be completed if there are any Borderline or Unsatisfactory ratings in the assessment form.

ACF Domain Issues related to specific domain Actions/tasks (Evidence required) Timeframe Review date

CLINICAL MANAGEMENT

1. Safe patient care

2. Patient assessment

3. Emergencies

4. Patient management

5. Skills and procedures

COMMUNICATION

6. Patient interaction

7. Managing information

8. Working in teams

PROFESSIONALISM

9. Doctor & society

10. Professional behaviour

Appendix 4: Sample Summative Supervisor’s Report Form

Guiding Principles

This form is to provide information about the performance of candidates at summative report meetings. The information on this form contributes to decisions on registration and is a mechanism for providing candidates in the WBA Program with feedback each term for their professional development and to guide learning.

This form will be submitted to the WBA Program Director and will be accessible to the Director of Clinical Training, the Medical Education Officer and the Director of Medical Services. At their discretion, information from this form may be passed on to other relevant people such as future term supervisors where there is considered a significant risk to patient safety.

This form must be discussed with the candidate undertaking the WBA program and should include a review of their Self-Assessment Form.

Supervisors are referred to the National Principles of Assessment and Guidelines for Supervisors for assistance in completing this form.

Instructions

Clinical Supervisors

1. Must observe the candidate in the workplace prior to assessing.

2. Are encouraged to include observations from multiple sources in developing this assessment e.g. other medical practitioners, nurses, allied health, patients.

3. Are to tick appropriate boxes in the columns provided.

4. Are required to make additional comments where there are ticks in the shaded area and complete the Improving Performance Action Plan (IPAP) overleaf, so as to commence the remediation process.

5. Return completed form to the Director of Clinical training who will review each form and action as required.

Candidate Name: __________________________________________________

Position: _________________________________________________

Unit: ____________________________________________________

Hospital: _________________________________________________

Date: ____________________________________

Report number: Report 1 Report 2

Orientation completed: Yes No

Assessment process discussed: Yes No

Specific learning objectives negotiated: Yes No

Please indicate which of the following method/s have been used to inform the completion of this assessment:

Close personal observation

General impressions:

Observations made by other team members:

Other e.g. Mini-CEX, DOPS

Please indicate other staff from whom you have sought feedback with regards to the candidate’s performance:

Consultants/s Registrars/s Nursing staff Others, specify ___________________

Workplace Based Assessment

Please list the number of Workplace Based Assessments used to inform your assessment of this candidate

Mini-CEX DOPS CBD

Clearly below the

level expected

Borderline Expected level

Clearly above

expected level

CLINICAL MANAGEMENT

1. Safe patient care

2. Patient assessment

3. Emergencies

4. Patient management

5. Skills and procedures

COMMUNICATION

6. Patient interaction

7. Managing information

8. Working in teams

PROFESSIONALISM

9. Doctor & society

10. Professional behaviour

11. Teaching and learning

Other Learning Objectives as agreed between the candidate and their Supervisor

12. ________________________________________

13. ________________________________________

14. ________________________________________

Please comment on the following in relation to the candidate’s performance:

1. Strengths

2. Areas for improvement:

3. Overall performance:

Formative Summative

Clearly below the level expected

Borderline

Expected level

Clearly above expected level

Clearly below the level expected

Borderline

Expected level

Clearly above expected level

4. Please outline any additional responsibilities which the candidate has undertaken in this term. For example, attendance at education committee meetings, State-based meetings.

Supervisor

Name: __________________________________________

Signature: _______________________________________

Position: ____________________________

Date: _______________________________

Candidate

I (the candidate) confirm that I have had the chance to discuss the above report with my assessor and know I may respond in writing within seven (7) days to the Director of Clinical Training should I disagree with any points made in this report.

Signature: ____________________________________ Date: __________________________

Reference:

CPMEC Australian Curriculum Framework

Improving Performance Action Plan (IPAP)

This section is used to address identified issues and must be completed if there are any Borderline or Unsatisfactory ratings in the assessment form.

ACF Domain Issues related to specific domain Actions/tasks (Evidence required) Timeframe Review date

CLINICAL MANAGEMENT

1. Safe patient care

2. Patient assessment

3. Emergencies

4. Patient management

5. Skills and procedures

COMMUNICATION

6. Patient interaction

7. Managing information

8. Working in teams

PROFESSIONALISM

9. Doctor & society

10. Professional behaviour

Appendix 5: Sample Final Report

Assessor: _______________________________________________ Date: ________________

Doctor: __________________________________________________

Position held ___________________________________________________________________

INSTRUCTIONS

For the doctor

This review form is to be completed by you first. This enables you to identify your strengths and any areas where you feel further improvement is necessary.

Using the Criteria (1-6 in the table below) complete the form by ticking the appropriate “Doctor” box which best describes your performance for each statement.

Once you have completed the form, give it to your supervisor to complete.

For the assessor

Consult the appraisal criteria and tick the appropriate “Supervisor box” which best describes the performance of this doctor. The ethical performance should be compared to the expected performance for this level of position and the length of time the doctor has been working in Western Australia.

You may wish to seek input into the assessment from other clinical and administrative staff, who may be more familiar with some aspects of the doctor’s performance.

Arrange a mutually agreeable time to meet with the doctor privately and discuss the review. Please complete the “Supervisor’s report” and “Comments” section if there are issues that need to be addressed. Both you and the doctor must sign the form at the end of the feedback session.

CRITERIA 1

Performs consistently well below the level expected

2

Performs consistently below the

level expected

3

Performs consistently at the level expected

4

Performs consistently above the

level expected

5

Not assessed

i.e. required in the role

but not observed

6

Not applicable

i.e. not required in

the role

Clinical Management

Documents a comprehensive patient history (including obtaining information from other sources when appropriate)

Doctor

Assessor

Conducts an appropriate patient examination

Doctor

Assessor

Documents patient examination/assessment appropriately

Doctor

Assessor

Requests appropriate investigations

Doctor

Assessor

Follows up investigations, and acts where necessary on results

Doctor

Assessor

CRITERIA 1

Performs

2

Performs

3

Performs

4

Performs

5

Not

6

Not

consistently well below the level expected

consistently below the

level expected

consistently at the level expected

consistently above the

level expected

assessed

i.e. required in the role

but not observed

applicable i.e. not

required in the role

Revises management plan as required

Doctor

Assessor

Develops an appropriate care management plan

Doctor

Assessor

Effectively coordinates patient care, including referral and follow-up

Doctor

Assessor

Recognises emergencies that occur in patient management

Doctor

Assessor

Manages emergencies that occur in patient management

Doctor

Assessor

Plans for discharge of patient (where relevant)

Doctor

Assessor

Documents discharge summary

Doctor

Assessor

Practices procedural skills relevant to current area of practice

Doctor

Assessor

Communication Communicates effectively (respectfully and with the ability to listen) with patients

Doctor

Assessor

Communicates effectively (respectfully and with the ability to listen) with the patient’s family

Doctor

Assessor

Accesses aids in communication where necessary (e.g. interpreter)

Doctor

Assessor

CRITERIA 1

Performs consistently well below the level expected

2

Performs consistently below the

level expected

3

Performs consistently at the level expected

4

Performs consistently above the

level expected

5

Not assessed

i.e. required in the role

but not observed

6

Not applicable

i.e. not required in

the role

Communicates effectively with other members of the health care team

Doctor

Assessor

Communicates effectively with professional colleagues including general practitioners (e.g. for handover, referral) transfer of patients)

Doctor

Assessor

Clearly documents all patient care

Doctor

Assessor

Professionalism Shows compassion for patients

Doctor

Assessor

Shows sensitivity to patient’s culture, ethnicity and spiritual issues

Doctor

Assessor

Is punctual

Doctor

Assessor

Demonstrates effective time management

Doctor

Assessor

Demonstrates ability to prioritise work

Doctor

Assessor

Demonstrates ability to recognise limitations in his/her practice and request assistance

Doctor

Assessor

Demonstrates recognition of role in society (obligation and responsibilities in the community and in hospital settings)

Doctor

Assessor

Demonstrates an understanding of indigenous issues/cultural affairs

Doctor

Assessor

CRITERIA 1

Performs consistently well below the level expected

2

Performs consistently below the

level expected

3

Performs consistently at the level expected

4

Performs consistently above the

level expected

5

Not assessed

i.e. required in the role

but not observed

6

Not applicable

i.e. not required in

the role

Safe Practice Demonstrates knowledge of common therapeutic agents – uses, dosages, adverse effects and potential drug interactions

Doctor

Assessor

Demonstrates knowledge of blood products

Doctor

Assessor

Ability to prescribe medication and treatment safely

Doctor

Assessor

Uses infection control principles in patient care

Doctor

Assessor

Recognises adverse incidents and acts on adverse incidents

Doctor

Assessor

Demonstrates a risk management approach throughout their practice

Doctor

Assessor

Assessor Report

Suggested areas for further learning and development:

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

Substantial improvement is required in the following areas (please complete a plan for remedial action below):

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

Evaluation of overall performance:

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

What contact was the assessment based on?

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Other members of unit/team/practice who provided information to supervisor for this report:

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

Comments and future development plan

The Assessor must complete this section if:

The doctor’s performance was recorded as “Performs consistently well below the level expected” or “Performs consistently below the level expected” in any aspect of the assessment; OR

There was a significant difference between the assessment of the supervisor and the self-assessment of the doctor.

Issues to be addressed

Issue Actions/Tasks to address Issue (including time frame) Review date

Doctor’s comments

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Signatures (both the doctor and assessor must sign)

I acknowledge that I have read and discussed the report with the assessor

Doctor DATE:

Suitable for ongoing employment Yes

No

Assessor DATE:

References

Eastern Health HMO Appraisal forms St Vincent’s Health HMO Appraisal forms A Guide for Interns in Victoria, Post Graduate Medical Council of Victoria and the Medical Practitioners Board of Victoria, 2006 Australian Curriculum Framework for Junior Doctors Medical Board of Queensland Assessment report for special purpose registrants PMCWA Junior Doctor End of Term Assessment Form

This document can be made available in alternative formats on request for a person with a disability.

© Department of Health 2017

Copyright to this material is vested in the State of Western Australia unless otherwise indicated. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the provisions of the Copyright Act 1968, no part may be reproduced or re-used for any purposes whatsoever without written permission of the State of Western Australia.