MERSEY DEANERY
TO:ALL SPECIALIST REGISTRARS/SENIOR REGISTRARS/REGISTRARS/ SENIOR HOUSE OFFICERS REQUESTING STUDY LEAVE
Attached to your Study Leave Application is a feedback form, which you are requested to complete and return with your expenses claim to your Postgraduate Clinical Tutor.
Your assistance in this matter is greatly appreciated, as it will enable the Postgraduate Dean to learn more about various courses/training opportunities around the country and overseas.
PLEASE NOTE: IF YOU DO NOT COMPLETE THE FEEDBACK FORM AND RETURN IT WITH YOUR CLAIM FOR EXPENSES, YOUR PAYMENT MAY BE SUBJECT TO DELAY.
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STUDY LEAVE FEEDBACK FORM
Complete and return with Study Leave Expenses Claim form
YOUR DETAILS:
FORENAME: ...... HOSPITAL CODE
SURNAME: ......
YOUR GRADE ...... SPECIALTY ……......
STUDY LEAVE DETAILS:
TITLE ...... ……………......
VENUE ...………...... …...... ……...... …......
ORGANISERS ...... …………......
DATE OF STUDY LEAVE:FROM ...... ……...... ……….. TO ...... ………......
l. AIMS AND OBJECTIVES
a. Who in your opinion was this course aimed at? (Please tick appropriate boxes)
CONSULTANTS
SPECIALIST REG/SENIOR REGISTRARS
SENIOR HOUSE OFFICERS
OTHERS, PLEASE SPECIFY ......
b. What were your aims in attending this course?c. To what extent were your aims met?
(Please delete appropriate) (Please circle as appropriate)
PART OF REQUIRED TRAININGYES/NO fully met 5 4 3 2 1 not at all
IN PREPARATION FOR EXAM YES/NO fully met 5 4 3 2 1 not at all
PRESENTATION OF PAPER YES/NO fully met 5 4 3 2 1 not at all
ATTENDANCE AT SPECIALTY MEETING YES/NO fully met 5 4 3 2 1 not at all
UPDATE ON RECENT ADVANCES YES/NO fully met 5 4 3 2 1 not at all
OBTAINING SKILLSYES/NO fully met 5 4 3 2 1 not at all
OTHERS PLEASE SPECIFY:. ……………….………….. fully met 5 4 3 2 1 not at all
d. If needs were not met, why not? ...... ………......
2. COURSE FEEDBACK (Please circle as appropriate)
a. Was the level of the course Too advanced 5 4 3 2 1 Too elementary
b. Was the length of Course Too long 5 4 3 2 1 Too short
c. Was the course content appropriate? YES/NO
d. Did the course material reflect the actual programme? YES/NO
e. Have you changed your practice as a result of attending this course? YES/NO/ NOT APPLICABLE
f. Did you sit a professional exam after this leave? YES/NO
g. If yes, did you pass? YES/NO/DON’T KNOW
h. If you DON’T KNOW yet, PLEASE SEND THE RESULT
LATER TO YOUR POSTGRADUATE CLINICAL TUTOR
i. Organisation of Course Very satisfied 5 4 3 2 1 Not very satisfied
3. OVERALL ASSESSMENT (Please circle as appropriate)
a. Bearing in mind the general objectives of the course
what is your overall assessment? Excellent 5 4 3 2 1 Unsatisfactory
b. Would you recommend this course to your successor
in post (if they were at the same stage as you) Highly recommended 5 4 3 2 1 Definitely not
- Would you regard this course as value for money
from the Postgraduate budget? Good value 5 4 3 2 1 Poor Value
4. ANY OTHER COMMENTS
......
...... …......
.....…...... ……………………………......
Signature:. ……………………….……….…......
Postgraduate Clinical Tutor/Director of Education
Date: …………………………......
For Postgraduate Clinical Tutor UseONLY
Overall assessment of the course including its value for money
Excellent Above Average Average Below Average Poor
Mersey Deanery,
Postgraduate Education & Training Department,
1st Floor,
Regatta Place,
Brunswick Business Park,
Summers Road,
Liverpool,
Merseyside L3 6AG.
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