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  • FORM 4: Summary of Appraisal Discussion: Trainee Name: Trainee Level

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    Matt Smith
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    This document is a summary of an appraisal discussion between a trainee and their educational supervisor. It includes sections to record the trainee's name, level of training, and ratings on topics like patient relations, collaboration, medical practice, teaching, and personal health. The trainee and supervisor must sign off to confirm the summary accurately reflects their discussion and any agreed upon personal development plans, and that the trainee has not been convicted of any crimes or disciplinary actions since their last appraisal.

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    FORM 4 Template

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    This document is a summary of an appraisal discussion between a trainee and their educational supervisor. It includes sections to record the trainee's name, level of training, and ratings on topics like patient relations, collaboration, medical practice, teaching, and personal health. The trainee and supervisor must sign off to confirm the summary accurately reflects their discussion and any agreed upon personal development plans, and that the trainee has not been convicted of any crimes or disciplinary actions since their last appraisal.

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    FORM 4: Summary of Appraisal Discussion: Trainee Name: Trainee Level

    Uploaded by

    Matt Smith
    This document is a summary of an appraisal discussion between a trainee and their educational supervisor. It includes sections to record the trainee's name, level of training, and ratings on topics like patient relations, collaboration, medical practice, teaching, and personal health. The trainee and supervisor must sign off to confirm the summary accurately reflects their discussion and any agreed upon personal development plans, and that the trainee has not been convicted of any crimes or disciplinary actions since their last appraisal.

    Copyright:

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    Download as DOC, PDF, TXT or read online from Scribd
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    of 1

    FORM 4: Summary of Appraisal Discussion

    This section includes the signed off Summary of your Appraisal. It is based on and must include all of the standards laid out in Good Medical Practice and it should be agreed and signed by your educational supervisor who is undertaking workplace based appraisal. TRAINEE NAME: TRAINEE LEVEL:
    1. 2. 3. 4. Relations with patients Working relationships with colleagues Maintaining good medical practice Good medical care

    5.
    6. 7.

    Teaching and training

    Probity

    Health

    SIGN OFF

    We agree that the information in Form 4 and 5 (optional) is an accurate summary of the appraisal discussion and agreed action, and of the agreed personal development plan. The trainee confirms since the last appraisal/revalidation he/she has not, in the UK or outside: been convicted of a criminal offence or have proceedings pending against me. had any cases considered by the GMC, other professional regulatory body, or other licensing body or have any such cases pending against me. had any disciplinary actions taken against me by an employer or contractor or have had any contract terminated or suspended on grounds relating to my fitness to practise. Educational supervisor________________________ Date ___ /___ /___ Trainee ____________________________________ GMC Number ___________

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