University of Bristol Medical School
Why is your feedback important?
Feedback from patients and their relatives helps medical students in their training to become better doctors. It helps to highlight their strengths and areas for improvement. The questions relate to how you felt a medical student interacted with you and, in particular, how they communicated and behaved.Completing this form is voluntary
Will providing feedback affect how you are treated?
No.Your feedback will be anonymous and treated in confidence and will not affect the quality of care you receive. Please do not write your name on the questionnaire.
Might feedback harm the medical student’s career?
Feedback is purely to help the medical student to work better with patients. Sometimes you may wish to make negative comments and these will help the student to identify areas for improvement.
How is the feedback used?
The student will develop a portfolio containing feedback forms. They will be required to think about and reflect upon the comments and discuss this with their academic mentor/tutor.
Name of medical student:Who is completing this form? (please circle as appropriate)
Patient / Relative / Friend / Carer / Parent / Health Professional/ Other
For each of the activities below please rate the medical student on the scale 1 (Poor) to 4 (Excellent) by circling the appropriate number or circling n/a if not applicable to this consultation.
Poor / Satisfactory / Good / Excellent / Not ApplicableIntroducing themselves / 1 / 2 / 3 / 4 / n/a
Listening to you / 1 / 2 / 3 / 4 / n/a
Being polite and courteous / 1 / 2 / 3 / 4 / n/a
Making you feel at ease / 1 / 2 / 3 / 4 / n/a
Being caring and compassionate / 1 / 2 / 3 / 4 / n/a
Explaining things to you / 1 / 2 / 3 / 4 / n/a
Treating you with respect / 1 / 2 / 3 / 4 / n/a
Maintaining your privacy and dignity / 1 / 2 / 3 / 4 / n/a
Acting without discrimination / 1 / 2 / 3 / 4 / n/a
What was particularly good about how the medical student communicated and behaved towards you?
How could the medical student improve the way that they communicated and behaved towards you?
Would you trust this medical student to be involved in the care of your family and friends?
(If not, please explain your reason(s))
Please place this form in the envelope provided and seal it.
The student will collect the envelope and give it to their academic tutor who will collate feedback forms from a number of patients. The tutor will review the anonymous feedback and use the information to guide the medical student in their training to become a doctor. If there are any issues about your care that you wish to raise please talk to a member of your healthcare team or contact the patient Advice and Liaison Service.
Thank you - your help with this is much appreciated