Academic candidate section: (Academic referees must complete this section. Clinical referees may be in a position to complete this section if supplying a reference for a candidate applying for an academic post). Knowledge and achievements - Demonstrates general knowledge / interest in science and academic medicine. 1 2 3 4 Below average Average knowledge in Good knowledge in Excellent knowledge knowledge in science science and academic science and academic in science and and academic medicine medicine medicine academic medicine Comments / evidence: Commitment to an academic career - Demonstration of understanding and commitment to academic career. 1 2 3 4 Has shown no interest in Limited interest in an Positive interest in an Actively seeking out an academic career academic career academic career academic opportunities for future career Comments / evidence: Academic potential - Demonstrates potential for a career in education / research through scientific publications and presentations. 1 2 3 4 No evidence of Some evidence of Active participation in Leading role for participation in participation in audit, teaching or audit, teaching or teaching or research teaching or research research research Comments / evidence: Academic Potential Potential to innovate by creating new ideas and influencing others. – 1 2 3 4 Fails to generate ideas Generates new ideas Generates new ideas Generates new or solutions that are and solutions with mixed and solutions with mainly ideas and solutions accepted by others results positive results on the that have a positive team impact on the team Comments / evidence:
Academic candidate section: (Academic referees must complete this section. Clinical referees may be in a position to complete this section if supplying a reference for a candidate applying for an academic post). Knowledge and achievements - Demonstrates general knowledge / interest in science and academic medicine. 1 2 3 4 Below average knowledge in science and academic medicine Average knowledge in science and academic medicine Good knowledge in science and academic medicine Excellent knowledge in science and academic medicine Comments / evidence: Commitment to an academic career - Demonstration of understanding and commitment to academic career. 1 2 3 4 Has shown no interest in an academic career Limited interest in an academic career Positive interest in an academic career Actively seeking out academic opportunities for future career Comments / evidence: Academic potential - Demonstrates potential for a career in education / research through scientific publications and presentations. 1 2 3 4 No evidence of participation in teaching or research Some evidence of participation in teaching or research Active participation in audit, teaching or research Leading role for audit, teaching or research Comments / evidence: Academic Potential – Potential to innovate by creating new ideas and influencing others. 1 2 3 4 Fails to generate ideas or solutions that are accepted by others Generates new ideas and solutions with mixed results Generates new ideas and solutions with mainly positive results on the team Generates new ideas and solutions that have a positive impact on the team Comments / evidence:
nihr_structured_reference_form_2017.docx