Doctorate in Clinical Psychology

Placement Review Form

Date of Review: / MPR / EPR (circle)
Clinical Tutor:


This form is to be used for both MPR and EPR visits. A typed (electronic) version will be sent by the visiting clinical tutor to the named senior clinical tutor at the university following the placement visit. A copy of the form (Part A) will be sent to the trainee and supervisor(s), and a copy will be kept in the trainee’s (confidential) file. The first section of the form (Part A) is considered open between trainee, supervisor and UH clinical tutor team; this should be made clear by the visiting clinical tutor. The second part of the form (Part B) provides space for any confidential comments, which trainee, supervisor or tutor would prefer not to have disclosed. This information will remain confidential within the UH clinical tutor team.

At the EPR an additional Placement Continuation form should be completed. This contains a summary of agreed learning needs, goals and gaps in experience to be passed on to the trainee’s next placement supervisor. This information will assist the new supervisor in planning the placement and preparing the draft placement contract.
Part A: (open)

Placement Evaluation
(Note to tutor: Review the placement, the opportunities for learning, the resources and the supervision; check that minimum standards are being met. Refer to Handbook)
Trainee Evaluation / Supervisor Evaluation / Action points / Tutor comments
Overall impression of the placement as a learning environment
Physical resources, admin support, computers, library etc.
Access to relevant policy documents
Range of experience available
Quality and quantity of supervision
Opportunities for observation
(has the trainee been observed yet? Use of recording in supervision? Joint work?)
Range of experience
(Note to tutor: What has the trainee done on the placement so far? How does this match with the placement goals? What are the remaining gaps in experience? Goals for the rest of the placement and/or for future placements? Refer back to the Placement Contract and to the guidelines on experience in the Handbook).
Experience acquired / Gaps / Goals/Plans / Tutor comments
(age, gender, ethnicity, ability level etc.)
Problem range:
Modes and type of work
(direct/indirect? Individual/group? Models: CBT? Other models? specify)
Trainee Evaluation / Supervisor Evaluation / Targets/goals / Tutor comments
Review of Competencies
(Note to tutor: Review the various competence areas with trainee and supervisor; monitor progress; note areas for development, any concerns and learning goals for the remainder of the placement and for future placements; if necessary refer to the Supervisor Evaluation form for further details on the competence areas. )
  • Professional Behaviour


  • Awareness of issues of power, difference and diversity

Autonomy & Independence

Organising workload, managing priorities & learning needs

  • Use of supervision
  • Self reflection

  • Knowledge(& ability to generalise knowledge)
  • Critical Thinking
  • Evidence-based practice

Trainee Evaluation / Supervisor Evaluation / Targets/goals / Tutor comments
  • Relationship Factors(with clients & carers– rapport, therapeutic alliance etc.)

Assessment (knowledge, skills, choice of procedure, administration, scoring, interpretation, risk assessment etc.)


Intervention – psychological therapies

Indirect intervention

Communication & Reporting (incl. note keeping)

Trainee Evaluation / Supervisor Evaluation / Targets/goals / Tutor comments

Team Working (i.e. ability to work within an MDT etc.)

  • Inter-professional working (incl. understanding roles of other team members)
  • Relationship factors (with colleagues, dealing with conflict etc.)
  • Consultation

Teaching & presentation skills

Leadership (understanding leadership role of the psychologist in practise).

Knowledge of the Organisation

Awareness of wider organisational issues & service context

General Comments / Summary:

I confirm that both trainee and supervisor have agreed to their comments included above being communicated to each other.

Clinical Tutor:Signed:

Part B. (Confidential)

Additional confidential feedback from trainee:

What will be done with this information?/ Action:

Additional confidential feedback from supervisor:

What will be done with this information?/ Action:

Additional confidential comments and observations from clinical tutor:

What will be done with this information?/ Action:

Doctorate in Clinical Psychology

Placement Continuation Form

This form is completed by the trainee’s clinical tutor at the End of Placement review in consultation with the clinical supervisor and the trainee. The continuation sheet will be passed on to the trainee’s next clinical supervisor.

Name of Trainee:

Name of Supervisor:



Training Needs (note any areas which may require further development or specific attention; consider each of the competence areas)

Gaps in Experience (note any gaps in the trainee’s experience so far)

Clinical Tutor: