Colleague Feedback Questionnaire

Colleague Feedback Questionnaire
1. Clinical Assessment: Diagnostic skill; performance of practical/technical procedures
2. Patient Management: Management of complex clinical problems; appropriate use of resources
3. Reliability: Conscientious and reliable; available for advice and help when needed; time management
4. Professional Development: Commitment to improving quality of service; keeps up-to-date with knowledge and skills
5. Teaching and Training: Contributes to the education and supervision of students and junior colleagues
6. Verbal Communication: Spoken English; communication with colleagues, patients, families and carers
7. Empathy and Respect: Is polite, considerate and respectful to patients and colleagues of all levels; compassion and empathy towards patients and their relatives
8. Team Player: Values the skills and contributions of multi-disciplinary team members
9. Leadership: Takes the leadership role when circumstances require; delegates appropriately
10. Do you have any concerns about the Probity or Health (physical or mental) of this doctor? If yes, specify in box below
*statements above with an ‘unacceptable’ or ‘outstanding’ rating you must give specific examples. This is a very important and useful part of the appraisal process. All your comments will be anonymous but will be reported back verbatim, so there is a risk of your identification from the nature of your comments.
Unacceptable – I have concerns
Outstanding – excellent performance
Below average – improvement needed
U/c – unable to comment
Good – doing a good job