ECTV Feedback Form

External Clinical Teaching Visit (ECTV) Feedback Form

Date
GP Registrar / Current Rotation / GPS
ECT Visitor / GPT1/PRRT1/GPT2/PRRT2/GPT3/ PRRT4/GPT4/ES/PRRT4 / Visit number
Consultations observed at this visit:
(gender, age, presentation) / Level of complexity
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 assess / Well below expected level of competence / Below expected level of competence / At expected level of competence / Above expected level of competence

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Domain 2: Applied Professional Knowledge And Skills
Is the registrar at the competency level expected for their level of training?
Unable to assess / Well below expected level of competence / Below expected level of competence / At expected level of competence / Above expected level of competence
Domain 3: Population Health and Context Of General Practice
Free text
Is the registrar at the competency level expected for their level of training?
Unable to assess / Well below expected level of competence / Below expected level of competence / At expected level of competence / Above expected level of competence
Domain 4: Professional and Ethical Role
Free text
Is the registrar at the competency level expected for their level of training?
Unable to assess / Well below expected level of competence / Below expected level of competence / At expected level of competence / Above expected level of competence

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Domain 5: Organisational and Legal Dimensions
Free text
Is the registrar at the competency level expected for their level of training?
Unable to assess / Well below expected level of competence / Below expected level of competence / At expected level of competence / Above expected level of competence
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?
Unable to assess / Well below expected level of competence / Below expected level of competence / At expected level of competence / Above expected level of competence
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?

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MCCC Office Use Only

The following should be discussed with the 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. Supervisors 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)

GPR’S FEEDBACK ON THE ECTV

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

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Questions to assist with completing the Domains:

(see also 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?

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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?

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Effective Date:1st January 2016

Created By:SME Team

______/ _____ / _____

Approved by:Director Medical Education and TrainingDate:

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