Faculty of Medical and Human Sciences

Faculty of Medical and Human Sciences

School of Medicine

SUPERVISOR’S ASSESSMENT FORYear 3/4STUDENT SELECTED COMPONENT

Student Supervisor Ref:

SSC title

Instructions about the assessment and this form

Thank you for supervising this student. This form includes 4 sections:

Section 1 is to assist the Supervisor to give feedback to the Student. After completion of this section, photocopies should be given to the student.

Section 2 requires the Supervisor to give the Student a grade for each of the three Assessment Domains. Grade definitions for Domains 2. (Work habits and performance) and 3. (Written report) are given in the table below.

Section 3 is for the Supervisor to give a Final grade based on the assessments in Section 2.

Section4 is for the Supervisor to detail any specific comments about the Student.

Deadline for returning this form:

Table of Grade definitions

This table gives the Grade definitions for Domains 2. (Work habits and performance) and 3. (Written report).

Grade / 1 / 2 / 3 / 4 / 5
Unsatisfactory / Cause for concern / Average / Above average / Excellent
Definition / • lacks motivation
• fails to respond to guidance and advice
• poor time management and poor organisation of basic tasks
• gross deficiencies in practical output
• written work inadequate, inaccurate with many omissions / • performance and output below average / • satisfactory on most of the criteria listed / • performance and output above average / • performance outstanding over a range of tasks
• highly motivated
• well organised, systematic approach
• thinks logically
• written work exceptionally good on the criteria listed

NOTE: a grade in between these grades is NOT permitted.

Section 1. Feedback to student

This section is to assist the Supervisor to give feedback to the Student. After completion of this section, photocopies should be given to the student.

Domain / Feedback(please circle) / Constructive comments
1. Attendance and punctuality / unsatisfactory
(<75% of the SSC period) / satisfactory
(≥75% of the SSC period)
Domain / Feedback for individual components(tick) / Constructive comments
2. Work habits and performance / Un-satisfactory / Cause for concern / Average / Above average / Excellent
Ability to identify own strengths and weaknesses and confront issues of concern
Motivation, enthusiasm and active participation
Seek and take advantage of available learning opportunities and resources
Application of knowledge and skills
Exploration of ethical, legal and moral issues
Working with health care professionals other than doctors
Achievement of specific learning objectives

Section 1. Feedback to student continued

Domain / Grade awarded for individual components / Comments
3. Written report / Un-satisfactory / Cause for concern / Average / Above average / Excellent
Presentation and structure
word processed with font size 10 or greater and double-spaced
word count 2000-5000 excluding references (~ 5-10 A4 pages). Note: an excessively long report will be penalised by awarding a lower grade and will not be awarded 'excellent'
organised into logical sections
tables and figures used appropriately
Abstract/Summary
maximum 200 words
clear and accurate summary of the content
Content
concise description of a specific case
understanding of a medical topic related to the case (which may be issues such as disease mechanism, public health aspects, prevention, epidemiology, treatment options and future development relating to a patient or group of patients, a family, a community or a health care service)
understanding illustrated through clear explanations and analyses
available information appraised critically and interpreted correctly
Use of literature
10-20 references and preferably not textbooks
appropriate range and pertinent to the topic
cited correctly and in a consistent style

Section 2Assessment grades for individual domains

Please circle one grade for each of the 3 Assessment Domains.

Domain / Grade (circle one grade for each domain)
1. Attendance / unsatisfactory
(<75% of PO period) / satisfactory
(≥75% of PO period)
2. Work habits and performance / unsatisfactory / cause for concern / average / above average / excellent
3. Written report / unsatisfactory / cause for concern / average / above average / excellent

Section 3Final assessment grade

Please circle one grade for the Final assessment. The grade definitions and pass/fail decision are included in the table.

Final grade / Unsatisfactory / Cause for concern / Average / Above average / Excellent
Definition / • attendance unsatisfactory
• lacks motivation
• fails to respond to guidance and advice
• poor time management and poor organisation of basic tasks
• gross deficiencies in practical output
• written work inadequate, inaccurate with many omissions / Attendance satisfactory
but
performance and output below average / Satisfactory on most of the criteria listed including attendance / Performance and output above average (attendance must be satisfactory) / • performance outstanding over a range of tasks
• highly motivated
• well organised, systematic approach
• thinks logically
• written work exceptionally good on the criteria listed
Decision / Fail / Pass / Pass / Pass / Pass

Please explain ‘Unsatisfactory’ and ‘Cause for concern’ in Section 4 or in a separate covering letter.

Section 4Specific comments about Student's performance and written report. Please write your comments overleaf

Signatures

Student ______Supervisor ______

Date ______

Please return this form to: Diane Broughton, Year 4 Teaching Coordinator, MedicalEducationBuilding, HopeHospital, Salford, M6 8HD

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Academic Year 2005-6