Severn Postgraduate Medical Education Example MSF Sheet - Team assessment of behaviour (TAB) Assessor’s position: Trainee Junior or Consultant/GP or Senior (Band 5+) or Allied Health Professional team member (please Senior doctor equivalent equivalent (please specify) specify) Name of doctor: GMC Number (if applicable): Training period from: From: To: Specialty Please use the comments box to commend good behaviour and to describe any behaviour which is causing you concern. Give specific examples. This form will be sent to the doctor’s supervisor, who may ask you privately to enlarge on any concern about behaviour you report. At least seven other forms will also be considered. The doctor will receive private feedback and you will not be identified in person without an advanced discussion with you. COMMENTS: anything especially good? If you cannot give an opinion due Attitude and/or behaviour No Some to lack of knowledge of the doctor say so here. You must specifically concern concern concern comment on any concern about behaviour and this should reflect the trainee’s behaviour over time not usually just a single incident. – Maintaining trust/professional relationship with patients Listens Is polite and caring Shows respect for patients’ opinions, privacy, dignity and is unprejudiced Verbal communication skills understandable information Speaks good English, at the appropriate level for the patient
Severn Postgraduate Medical Education Example MSF Sheet - Team assessment of behaviour (TAB) Assessor’s position: Trainee Junior or Senior doctor Consultant/GP or equivalent Senior (Band 5+) or equivalent Allied Health Professional (please specify) team member (please specify) Name of doctor: GMC Number (if applicable): Training period from: From: To: Specialty Please use the comments box to commend good behaviour and to describe any behaviour which is causing you concern. Give specific examples. This form will be sent to the doctor’s supervisor, who may ask you privately to enlarge on any concern about behaviour you report. At least seven other forms will also be considered. The doctor will receive private feedback and you will not be identified in person without an advanced discussion with you. Attitude and/or behaviour No concern Some concern concern COMMENTS: anything especially good? If you cannot give an opinion due to lack of knowledge of the doctor say so here. You must specifically comment on any concern about behaviour and this should reflect the trainee’s behaviour over time – not usually just a single incident. Maintaining trust/professional relationship with patients Listens Is polite and caring Shows respect for patients’ opinions, privacy, dignity and is unprejudiced Verbal communication skills understandable information Speaks good English, at the appropriate level for the patient
Team-Assessment-of-Behaviour-Form.docx