ECTV Feedback Form

External Clinical Teaching Visit (ECTV)

ECTV Feedback Form Page 1 of 9 Date

GP Registrar Current Rotation GPS

ECT Visitor GPT1/PRRT1/GPT2/PRRT2/GPT3/ Visit number PRRT4/GPT4/ES/PRRT4

ECT Visitor please complete

This page only will not be visible to Registrar, Practice or Supervisor You are given time at the beginning at the ECTV session to discuss the term with the GPR

The following should be discussed with the Registrar (GPR)

Any issues identified by MEs or that are raised by the GPR should be noted in the comments box below. If there are no issues or concerns then simply write “no issues”. (please note that these questions and responses form part of the Practice File and NOT the registrar’s file)

1. Patient numbers? (Too many/not enough?)

2. Variety of consults?

3. Teaching (appropriate time, frequency and also quality)? 4. Supervisor’s availability to answer questions?

5. Working environment e.g. staff, colleagues, facilities etc? 6. Was orientation conducted at the commencement of the term and was it satisfactory? (Orientation should cover the following areas: general introduction to the practice; reception area and office procedures; practice nurse, treatment room and treatment room procedures; IT and computer software; documentation requirements; consulting room; Practice policies; expectations regarding professional behaviour) Comments:

External Clinical Teaching Visit (ECTV) Consultations Feedback Form

ECTV Feedback Form Page 2 of 9 Date

GP Registrar Current Rotation GPS

ECT Visitor GPT1/PRRT1/GPT2/PRRT2/GPT3/ Visit number PRRT4/GPT4/ES/PRRT4

Consultations observed at this visit: Level of complexity (gender, age, presentation) Low Med High Patient 1: Patient 2: Patient 3: Patient 4: Patient 5: Patient 6:

Domain 1: Communication Skills and the Patient Doctor Relationship

Is the registrar at the competency level expected for their level of training?

Unable to Well below Below expected At expected level of Above expected level assess expected level of level of competence of competence competence competence

Domain 2: Applied Professional Knowledge And Skills

ECTV Feedback Form Page 3 of 9 Unable to Well below Below expected At expected level of Above expected level assess expected level of level of competence of competence competence competence

Domain 3: Population Health and Context Of General Practice

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Domain 4: Professional and Ethical Role

Free text

Domain 5: Organisational and Legal Dimensions

Free text

ECTV Feedback Form Page 4 of 9 Overall comments (including areas to be worked on)

As an overall assessment, is the registrar at the competency level expected for their level of training?

Has this feedback been discussed with the supervisor? YES NO N/A Has the Learning Plan/Log Book been reviewed and discussed with the registrar? YES NO N/A

Exam When is the GPR intending to sit the exam?

ECTV Feedback Form Page 5 of 9 Registrar’s feedback on the ECTV

If this form is completed manually, these questions will be sent to the registrar via a separate email.

Do you have any feedback for the Visitor who conducted your ECTV?

Comments

What have you gained from this ECTV? Are there any learning needs do you wish to put into your Learning Planner?

Comments

ECTV Feedback Form Page 6 of 9 Questions to assist with completing the Domains:

See the ECTV Manual for a more extensive checklist

Communications Skills and the Patient Doctor Relationship

How effective and how consistent are the registrar’s verbal communication skills with the patient? Does the GPR establish rapport?

Does the GPR demonstrate sympathy and empathy appropriately and effectively? Is the GPR non-judgmental?

Does the GPR have good listening skills? (including use of silence and picking up patient cues) Does the GPR engender confidence and trust? (including appropriate use of body language) Does the GPR use a biopsychosocial approach?

Does the GPR provide relevant and an appropriate amount of information tailored to the patient’s level of understanding and needs? (this includes checking the patient’s knowledge and understanding and avoidance of jargon) Does the GPR communicate effectively with the patient’s “significant others”?

Applied Knowledge and Skills

Does the GPR take a history and perform physical examination appropriate to the presenting problem(s)? Does the GPR order investigations judiciously and does the GPR interpret and/or the results appropriately? Does the GPR consider the possibility of serious illness where necessary?

Does the GPR recognize serious illness and act appropriately in managing it?

Does the GPR arrive at an appropriate diagnosis and/or management plan? (this includes the ability to synthesise information from different sources and make decisions) Can the GPR manage undifferentiated problems? (this includes dealing with uncertainty, resourcefulness and lateral thinking) Can the GPR manage a broad range of presenting problems, from simple to complex? Does the GPR prescribe rationally?

Does the GPR make appropriate use of referral services?

Does the GPR have self-awareness, insight into patient problems and reflective abilities? Does the GPR recognize their limitations?

Continued next page

ECTV Feedback Form Page 7 of 9 Population Health and the Context of General Practice

Does the GPR consider and address the broader biopsychosocial issues that impact on the patient’s health? (this refers to lifestyle, socio-political, economic, work, spiritual, cultural, family and significant relationships) Does the GPR consider and appropriately address issues relating to illness prevention, disease screening and health promotion? Does the GPR consider and appropriately address issues of public health and safety? (this includes iatrogenic diseases, notifiable diseases, access and equity issues) Does the GPR make judicious use of community resources?

Does the GPR participate in community programs of health promotion and prevention?

Professional and Ethical

Does the GPR demonstrate a duty of care to the patient? (this includes taking responsibility for the optimal care of the patient, putting the patient first, mandatory reporting and advocacy, consent and confidentiality) Does the GPR respect patient rights and the patient’s cultural values?

Does the GPR adhere to the standards of professional work and ethical practice?

Does the GPR demonstrate a commitment to life-long learning and professional development? Does the GPR work well with others (staff, colleagues, allied health professionals)?

Does the GPR demonstrate an understanding of work-life balance, self-care and having a professional support network? Does the GPR respond appropriately to feedback?

Organisational and Legal

Does the GPR have good personal, organizational and time management skills?

Does the GPR maintain appropriate clinical records? (this includes communication and transfer of patient information) Does the GPR adhere to office policies and procedures? (this includes appropriate billing and adhering to prescribing guidelines) Does the GPR utilize information technology appropriately and effectively? (this includes web resources, recall systems) Does the GPR understand and implement appropriate practice safety procedures as regards patient safety (including recall and reminder systems) and personal safety?

ECTV Feedback Form Page 8 of 9 Effective Date: 1st January 2016

Created By: SME Team

______/ _____ / _____

Approved by: Director Medical Education and Training Date:

MCCC may amend and vary this form from time to time.