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Candidate Appraisal Form 2025

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najwanadeem27
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130 views2 pages

Candidate Appraisal Form 2025

Uploaded by

najwanadeem27
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Specialist Anaesthesiology Training Programme

Reference Form
Section One – General Information
Name of candidate: Medical Council Number:

This person worked under my supervision from: To:

Clinical Site: Country:

Speciality: Grade (Intern, SHO):

Are you in any way related to the applicant: Yes ____ No ____

Relationship:

Section Two – Professional Attitude


Professionalism Satisfactory Unsatisfactory

Diagnostic Skills Satisfactory Unsatisfactory

Diligence in record taking Satisfactory Unsatisfactory

Clinical judgement Satisfactory Unsatisfactory

Punctuality Satisfactory Unsatisfactory

Relationship with other medical colleagues Satisfactory Unsatisfactory

Relationship with nursing, paramedical and allied health staff Satisfactory Unsatisfactory

Relationship with patients and relatives Satisfactory Unsatisfactory

Section Three – Personal Attributes


Time Management Satisfactory Unsatisfactory

Management of stress and workload Satisfactory Unsatisfactory

Commitment and motivation Satisfactory Unsatisfactory

Communication Skills Satisfactory Unsatisfactory

Disposition and appearance Satisfactory Unsatisfactory

Reliability Satisfactory Unsatisfactory

Teamwork Satisfactory Unsatisfactory

Attendance and performance at conferences Satisfactory Unsatisfactory


Section Four – Additional Questions
Did this doctor perform well in this post ? Very Well Acceptable Not Acceptable

Would you be happy to work again with this doctor? Yes No

To your knowledge, has this candidate ever been the subject of a complaints process/investigation relating to a
patient incident. If yes please provide more details under the comments section. Yes No

Do you think this doctor is suitable for a career in Anaesthesiology? Yes Unsure No

Has this doctor any outstanding characteristics?

Other Comments:

Your Full Name: ______________________________________

Job Title: ____________________________________________ This form will not be accepted


without a Hospital Stamp

Telephone Number: ___________________________________

Signed Date: _________________________________________

** Note for Referees and Candidates

Candidates please note that as set out in the application form for the SAT programme, that for the purpose of employment, and
in accordance with the Data Protection Acts 1998 and 2003 , this form will be made available to the relevant employers/training
sites if you are successful in your application to the SAT programme.

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