JuniorDoctortermassessmentform

JuniorDoctorname Position

Unit/Department Hospital

Term

Thisformisbeing completedfor:

Midterm

Endofterm

Selfassessment

NOTE:PleaseutiliseAppendixTwo:PerformanceRatingKeywhencompletingthisform

Domain1:Scienceandscholarship–TheJuniorDoctorasscientistandscholar

1.1Consolidate,expandandapplyknowledgeofthe
aetiology,pathology,clinicalfeatures,naturalhistoryand prognosisofcommonandimportantpresentationsatall stagesoflife. / Not observed / 1
rarely / 2 / 3
usually / 4 / 5
always
CommentsonDomain1:

Domain2:Clinicalpractice–TheJuniorDoctoraspractitioner

Not observed / 1
rarely / 2 / 3
usually / 4 / 5
always
2.1Placetheneedsandsafetyofpatientsatthecentreofthe careprocess.Demonstratesafetyskillsincludingeffective
clinicalhandover,gradedassertiveness,infectioncontrol,and adverseeventreporting.
2.2Communicateclearly,sensitivelyandeffectivelywith patients,theirfamily/carers,doctorsandotherhealth
professionals.
2.3Performanddocumentapatientassessment-
incorporatingaproblemfocusedmedicalhistorywith arelevantphysicalexaminationandgenerateavalid differentialdiagnosis.
2.4Arrangecommon,relevantandcost-effective
investigations,andinterprettheirresultsaccurately.
2.5Safelyperformarangeofcommonproceduralskills requiredforworkattheirlevel.
2.6Makeevidence-basedmanagementdecisionsin
conjunctionwithpatientsandothersinthehealthcareteam.
2.7Prescribemedicationssafely,effectivelyandeconomically,includingfluid,electrolytes,bloodproductsandselected
inhalationalagents.
2.8Recogniseandassessdeterioratingandcriticallyunwellpatients whorequireimmediatecare.Performbasicemergencyandlife supportprocedures,includingcaringfor theunconsciouspatientand performingcardiopulmonaryresuscitation.
2.9Retrieve,interpretandrecordinformationeffectivelyinclinical datasystems(bothpaperandelectronic).
CommentsonDomain2:

Domain3:Healthandsociety–TheJuniorDoctorasahealthadvocate

Not observed / 1
rarely / 2 / 3
usually / 4 / 5
always
3.1Applyknowledgeof populationhealth,includingissuesrelating tohealthinequitiesandinequalities;diversityofcultural,spiritualand communityvalues;andsocio-economicandphysicalenvironment factors.
3.2Applyknowledgeoftheculture,spiritualityand
relationshiptolandofAboriginalandTorresStraitIslander peoples,toclinicalpracticeandadvocacy.
3.3Demonstrateabilitytoscreenpatientsforcommon
diseases,providecareforcommonchronicconditions,and effectivelydiscusshealthcarebehaviourswithpatients.
3.4Participateinqualityassurance,qualityimprovement,risk managementprocesses,and/orincidentreporting.
CommentsonDomain3:

Domain4:Professionalismandleadership–TheJuniorDoctorasaprofessionalandleader

Not observed / 1
rarely / 2 / 3
usually / 4 / 5
always
4.1Providecareto allpatientsinaccordancewith GoodMedical Practice:ACodeofConductforDoctorsinAustralia*, and demonstrateethicalbehavioursandprofessionalvaluesincluding integrity,compassion,empathyandrespectfor allpatients,society andtheprofession.
4.2Optimisetheirownpersonalhealthandwellbeing, includingrespondingtofatigue,managingstressand adheringtoinfectioncontroltomitigatehealthrisksofprofessionalpractice.
4.3Self-evaluatetheirownprofessionalpractice,demonstrate lifelonglearningbehaviours,andparticipateineducating
colleagues.
4.4Takeincreasingresponsibilityforpatientcarewhile
recognisingthelimitsoftheirownexpertiseandinvolving
otherprofessionalsasneededtocontributetopatientcare.
4.5Respecttherolesandexpertiseofotherhealthcare professionals,learnandworkeffectivelyasamemberor
leaderofaninter-professionalteam,andmakeappropriate referrals.
4.6Effectivelymanagetimeandworkloaddemands,be
punctualandshowabilitytoprioritiseworkloadtomanage patientoutcomesandhealthservicefunctions.
CommentsonDomain4:

Pleasecommentonthefollowing:

1.Strengths

2.Areasforimprovement

3.Overallperformance/Globalrating:(pleasetickoneresponse)

□Unsatisfactory(hasnotmettherequirementsofthetermandremediationisrequired)

□Borderline(furtherevaluationofperformanceandremediationrequired)

□Satisfactory(mettherequirementsoftheterm)

□Oustanding(top10%ofcohort)

DoesanImprovementPerformanceActionPlan(IPAP)needtobecompleted?YES/NO

WhereaJuniorDoctorrequiressignificantimprovementanIPAPisrequired

Pleasesupporttheaboveperformanceratingwithinformationandcomments

4.Thisassessmentformhasbeenbasedon

□Closepersonalobservation

□GeneralImpressions

□Observationsmadebyotherteammembers

5.PleaseindicatefromwhomyouhavesoughtfeedbackwithregardtotheJuniorDoctor’sperformance

□Consultant/s Registrar/s NursingStaff/s Others(specify)

6.TheJMOhasreceivedformalfeedbackaboutthisassessmentYES NO

Supervisor

NamePosition

SignatureDate

JuniorDoctor

I(thejuniordoctor)confirmthatIhavehadthechancetodiscusstheabovereportwithmyassessorandknowImayrespondinwritingtotheDirectorofClinicalTrainingwithin14daysshouldIdisagreewithanypoints.

JuniorDoctorcomments

SignatureDate

DirectorofClinicalTraining

NamePosition

SignatureDate

PleasereturnthecompletedformtotheDepartmentofPostgraduateMedicalEducation.