REGISTRAR FEEDBACK FORM

Practice:
GP Registrar:
Placement: / ☐ GPT1 / ☐ GPT2 / ☐ GPT3 / ☐ GPT4 / ☐ ES
Facility:
GP Supervisor:
Feedback:
Date completed:

This form consists of two sections, one providing feedback on the practice and supervisor, and the second recording your reflection on your learning and goals during placement.

Orientation

Was orientation to the practice conducted at the beginning of the term?
☐ Yes / ☐ No
Was it appropriate to your needs?
☐ Yes / ☐ No
Please comment on the adequacy of the orientation
What information is the feedback based on?
How often has each teaching method below been utilised by your supervisor to date? / 0 / 1-2x / 3-5x / =6x
Direct Observation (Sitting in) / ☐ / ☐ / ☐ / ☐ /
Direct Observation (Video Review) / ☐ / ☐ / ☐ / ☐ /
Formal clinical case discussion / ☐ / ☐ / ☐ / ☐ /
Informal clinical case discussion / ☐ / ☐ / ☐ / ☐ /
Clinical audit / ☐ / ☐ / ☐ / ☐ /
Feedback from staff and patients / ☐ / ☐ / ☐ / ☐ /
Learning planner / ☐ / ☐ / ☐ / ☐ /
Learning needs analysis / ☐ / ☐ / ☐ / ☐ /
Random case analysis / ☐ / ☐ / ☐ / ☐ /
Other (if other please specify e.g. Tutorials, role plays / ☐ / ☐ / ☐ / ☐ /
If you have selected 0 for both direct observation options, please comment on how your supervisor assessed your communication skills

Domain Feedback

Please complete the feedback below by considering the Domains and by referring to the question lists as well as the expected competencies for each training level.

Teaching and Learning

How would you rate the teaching provided?
☐ / Unable to Assess / ☐ / Well below expectation / ☐ / Below expectation / ☐ / At expectation / ☐ / Above expectation
How effective was the teaching provided by your supervisor during the term?
What were your supervisor’s strengths?
How effectively did you learn during this term?
Refer also to the checklist in responding to this question.

Supervision

Quality in supervision means that the supervisor (or the delegate) is readily available for teaching, support and discussion.

How would you rate the quality of supervision?
☐ / Unable to Assess / ☐ / Well below expectation / ☐ / Below expectation / ☐ / At expectation / ☐ / Above expectation
How available was your supervisor when you needed help?
Did you feel comfortable in asking your supervisor questions?
Refer also to the checklist in responding to this question.

Clinical encounters

The GP Registrar manages a sufficient number and variety of patients and presentations to meet curriculum requirements and learning needs.

How would you rate the clinical encounter?
☐ / Unable to Assess / ☐ / Well below expectation / ☐ / Below expectation / ☐ / At expectation / ☐ / Above expectation
Please comment as to how valuable your patient encounters were with respect to your learning?
Refer also to the checklist in responding to this question.

Practice Environment and Practice Management

The practice environment provides a quality and well supported environment that protects both registrar and patients.

How would you rate the practice environment and management?
☐ / Unable to Assess / ☐ / Well below expectation / ☐ / Below expectation / ☐ / At expectation / ☐ / Above expectation
How readily would you recommend this practice to other registrars?
Refer also to the checklist in responding to this question

Facility Rating

This section is only visible to you and MCCC. Your supervisor will not have access to this information.

How likely are you to recommend this facility to other registrars?
1(worse) to 10(best)
☐ / 1 / ☐ / 2 / ☐ / 3 / ☐ / 4 / ☐ / 5 / ☐ / 6 / ☐ / 7 / ☐ / 8 / ☐ / 9 / ☐ / 10
If the facility rating is less than 5 please comment why?

Questions to assist with completing the Domains:

Teaching and Learning

For excellence to be achieved in teaching, the supervisory team should be:

  • Flexible with respect to their teaching methods
  • Comprised of excellent clinicians, role models, teachers and mentors who provide quality training
  • Adaptable in their teaching methods to the registrar’s level of competence and training needs

For learning to be effective:

  • Learning activities should be planned and structured
  • Learning activities should be referenced to the curriculum, the context of the training post and the registrar’s learning need
  • The registrar should be well supported and their development optimised

Supervision

  • GPT1: 3hrs/week teaching time, of which 1hr is face to face; supervisor is present on site 80% of the time (except in the first month when they should be present 100% of the time) Supervisor must be contactable at all times.
  • GPT2: 1.5hrs/week teaching time, of which 1hr is face to face; supervisor is present on site 50% of the time. Supervisor must be contactable at all times.
  • GPT3: 45min/week teaching time; supervisor is present on site 25% of the time. Supervisor must be contactable at all times.

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