TRAINEE REFERRAL FRAMEWORK Trainee Demographics Trainee Name GMC/GDC/PH number Email address Mobile number (Please do not use Trust email) Specialty Training grade Current Placement GP Training Scheme (if applicable) Educational Supervisor name ES Supervisor name CS email Training Programme Director name TPD email Does this trainee have GMC undertakings? Yes No Do you have concerns Fitness to Practice (FtP)? Yes No Details of any current investigation: Type of Concern (please put an x in the relevant boxes and use the free text box below to provide further information) Clinical Performance, Health and Social Knowledge and Issues Skills Professional Communication, Behaviour and Team Working and Attitude Time Management Environmental Significant Life Issues Event (i.e. divorce, (I.e. Inappropriate workload, poor culture, relationship break training environment, up etc) lack of support in the workplace)
TRAINEE REFERRAL FRAMEWORK Trainee Demographics Trainee Name GMC/GDC/PH number Email address (Please do not use Trust email) Mobile number Specialty Training grade Current Placement GP Training Scheme (if applicable) Educational Supervisor name ES Supervisor name CS email Training Programme Director name TPD email Does this trainee have GMC undertakings? Yes No Do you have concerns Fitness to Practice (FtP)? Yes No Details of any current investigation: Type of Concern (please put an x in the relevant boxes and use the free text box below to provide further information) Clinical Performance, Knowledge and Skills Health and Social Issues Professional Behaviour and Attitude Communication, Team Working and Time Management Significant Life Event (i.e. divorce, relationship break up etc) Environmental Issues (I.e. Inappropriate workload, poor culture, training environment, lack of support in the workplace)
2018_psu_framework_referral_form_.docx