RMO (PGY2+) training

Term assessment form NALHN: MODBURY HOSPITAL

LYELL McEWIN
HOSPITAL

RMO details Term details

Name: From (dd/mm/yyyy):

To (dd/mm/yyyy):
This form is being completed for
Term number:
Mid-term End-of-term
Unit where term undertaken:
Intern self-assessment

About this form

The purpose of this form is to provide feedback to the Resident Medical Officer (RMO) on their
performance throughout the year.
The form is to be completed by the term supervisor and by the RMO (for self-assessment) at the mid-point
in any term longer than five weeks and at the end of the term.
This form has not been designed for recruitment purposes and should not be used for such purposes.

Instructions for RMOs

Complete this form before assessment meetings and discuss it with your supervisor at those meetings.
Consider your strengths and areas where you could benefit from additional experience. Your self-
assessment is not for submission.

Instructions for Supervisors

Complete and discuss the form with the RMO. Consider the RMO’s self-assessment and the observations
of others in the discussion. The supervisor should:
• Assign a rating for the RMO’s performance against each outcome statement. Note: assigning a rating
of 2 or 4 indicates that the performance falls between the descriptions provided.
• Use the ‘Not observed’ option where appropriate and note this for further action.
• Complete an Improving Performance Action Plan (IPAP) when an RMO requires remediation or
additional support (e.g. when the RMO is assigned ratings of 1 or 2 for one or more items.)
• At the end-of-term assessment, assign a global rating for the rotation. Review any existing
remediation plan to determine if it is complete, or if ongoing actions are required.

Page 1 of 8
Domain 1: Science and scholarship – The RMO as scientist and scholar

1.1 Knowledge: Consolidate, expand and apply knowledge Comments on Domain 1

of the aetiology, pathology, clinical features, natural
history and prognosis of common and important
presentations at all stages of life.

Rating: Description: Not observed

5 Applies extensive knowledge to patient care

3 Applies sound knowledge to patient care

1 Demonstrates inadequate knowledge

Domain 2: Clinical practice – The RMO as practitioner

2.1 Patient safety: Place the needs and safety of patients at 2.2 Communication: Communicate clearly, sensitively and
the centre of the care process. Demonstrate safety skills effectively with patients, their family/carers, doctors and
including effective clinical handover, graded other health professionals.
assertiveness, delegation and escalation, infection
control, and adverse event reporting.

Rating: Description: Not observed Rating: Description: Not observed

5 Demonstrates all aspects of safe patient care 5 Communicates effectively in routine and difficult
situations

4 4

3 Demonstrates most aspects of safe patient care 3 Communicates effectively in routine situations

2 2

1 Demonstrates unsafe patient care 1 Does not communicate effectively

2.3 Patient assessment: Perform and document a patient 2.4 Investigations: Arrange common, relevant and cost-
assessment - incorporating a problem focused medical effective investigations, and interpret their results
history with a relevant physical examination and accurately.
generate a valid differential diagnosis.

Rating: Description: Not observed Rating: Description: Not observed

5 Performs and documents focused patient 5 Identifies and arranges appropriate investigations
assessments for routine and complex patients and interprets investigations accurately

4 4

3 Performs and documents focused patient 3 Arranges appropriate investigations and requires
assessments for routine patients some guidance on interpretation

2 2

1 Performs unfocused or incomplete patient 1 Arranges inappropriate investigations and/or

assessments and/or documentation interprets incorrectly

Page 2 of 8
2.5 Procedures: Safely perform a range of common 2.6 Patient management: Make evidence-based
procedural skills required for work as an RMO. management decisions in conjunction with patients and
others in the healthcare team.

Rating: Description: Not observed Rating: Description: Not observed

5 Performs procedures with a high degree of 5 Applies evidence, protocols and guidelines to
technical proficiency and sensitivity towards manage routine and complex patients
patients

4 4

3 Performs most common procedures in a technically 3 Applies evidence, protocols and guidelines to
safe and effective manner on routine patients manage routine patients

2 2

1 Performs common procedures with limited technical 1 Does not apply evidence, protocols and guidelines
proficiency and sensitivity to patients in patient management

2.7 Prescribing: Prescribe medications safely, effectively 2.8 Emergency care: Recognise and assess deteriorating
and economically, including fluid, electrolytes, blood and critically unwell patients who require immediate
products and selected inhalational agents. care. Perform basic emergency and life support
procedures, including caring for the unconscious patient
and performing cardiopulmonary resuscitation.

Rating: Description: Not observed Rating: Description: Not observed

5 Consistently prescribes and initiates therapy safely 5 Identifies deteriorating or critically unwell patients,
and adheres to all relevant protocols initiates management, actively anticipates
additional requirements and seeks appropriate
assistance

4 4

3 Prescribes safely and adheres to relevant protocols 3 Identifies deteriorating or critically unwell patients,
in most situations and seeks assistance when initiates basic management and seeks appropriate
needed assistance

2 2

1 Makes frequent prescribing errors 1 Does not identify deteriorating or critically unwell
patients or cannot initiate basic management
correctly or does not seek appropriate assistance

2.9 Information management: Retrieve, interpret and Comments on Domain 2

record information effectively in clinical data systems
(both paper and electronic).

Rating: Description: Not observed

5 Is diligent, timely and accurate in the use and

recording of all information in clinical data systems

3 Is consistent in recording information in clinical data

systems with appropriate levels of detail and
timeliness

1 Does not record information in clinical data systems

in an effective or timely manner

Page 3 of 8
Domain 3 – Health and society – The RMO as a health advocate

3.1 Population health: Apply knowledge of population 3.2 Aboriginal and Torres Strait Islander health: Apply
health, including issues relating to health inequities and knowledge of the culture, spirituality and relationship to
inequalities; diversity of cultural, spiritual and community land of Aboriginal and Torres Strait Islander peoples, to
values; and socio-economic and physical environment clinical practice and advocacy.
factors.

Rating: Description: Not observed Rating: Description: Not observed

5 Advocates effectively for the health needs of 5 Practises and advocates cultural safety for
different patient groups in patient care Aboriginal and Torres Strait Islander peoples

4 4

3 Considers the health needs of different patient 3 Practises cultural safety for Aboriginal and Torres
groups in patient care Strait Islander peoples

2 2

1 Does not recognise the health needs of different 1 Disregards cultural safety for Aboriginal and Torres
patient groups in patient care Strait Islander peoples

3.3 Comorbidities: Demonstrate ability to screen patients 3.4 Quality assurance: Participate in quality assurance,
for common diseases, provide care for common chronic quality improvement, risk management processes, and
conditions, and effectively discuss healthcare behaviours incident reporting.
with patients.

Rating: Description: Not observed Rating: Description: Not observed

5 Identifies all comorbidities and initiates appropriate 5 Advocates for and actively participates in quality
management improvement activities and incident reporting

4 4

3 Identifies common comorbidities and initiates 3 Participates in quality improvement activities and
satisfactory management incident reporting

2 2

1 Disregards the potential for comorbidities and/or is 1 Does not participate in quality improvement
unable to initiate management activities and fails to report incidents

Comments on Domain 3

Page 4 of 8
Domain 4 – Professionalism and leadership – The RMO as a professional and leader

4.1 Professionalism: Provide care to all patients in 4.2 Self-management: Optimise their personal health and
accordance with Good Medical Practice: A Code of wellbeing, including responding to fatigue, managing
Conduct for Doctors in Australia1, and demonstrate stress and adhering to infection control to mitigate health
ethical behaviours and professional values including risks of professional practice.
integrity, compassion, empathy and respect for all
patients, society and the profession.

Rating: Description: Not observed Rating: Description: Not observed

5 Behaves in a highly professional manner and is a 5 Manages the impact of work on personal health
role model for others and wellbeing and actively supports others

4 4

3 Behaves in a professional manner and occasionally 3 Manages the impact of work on personal health
needs assistance when under stress and wellbeing

2 2

1 Behaves in a manner that demonstrates disregard 1 Demonstrates impaired professional performance

for professional standards or other evidence of poor self-care

4.3 Self-education: Self-evaluate their professional 4.4 Clinical responsibility: Take increasing responsibility
practice, demonstrate lifelong learning behaviours, and for patient care while recognising the limits of their own
participate in educating colleagues. expertise and involving other professionals as needed to
contribute to patient care.

Rating: Description: Not observed Rating: Description: Not observed

5 Demonstrates reflective practice and seeks 5 Demonstrates sound judgement and accountability
opportunities for on-the-job learning and teaching of that enables greater responsibility and autonomy
others

4 4

3 Is able to self-evaluate and articulate personal 3 Demonstrates initiative and takes responsibility
learning goals within the limits of expertise

2 2

1 Lacks insight into learning needs and does not seek 1 Lacks insight into limitations and requires
or act on feedback continued close supervision

4.5 Teamwork: Respect the roles and expertise of other 4.6 Time management: Effectively manage time and
healthcare professionals, learn and work effectively as a workload demands, be punctual and show ability to
member or leader of an inter-professional team, and prioritise workload to manage patient outcomes and
make appropriate referrals. health service functions.

Rating: Description: Not observed Rating: Description: Not observed

5 Works effectively as a member or leader of the 5 Effective management and high work output
inter-professional team and positively influences without undue personal stress
team dynamics

4 4

3 Works effectively as part of the inter-professional 3 Effective management and prioritisation of most
team tasks and may need assistance during very busy
times

2 2

1 Works in a way that disrupts effective functioning of 1 Unable to manage and prioritise tasks in a timely
the inter-professional team manner resulting in task build-up

Page 5 of 8
Comments on Domain 4

Does an Improving Performance Action Plan (IPAP) need to be completed?

Yes No
Please refer to the instructions on page 1. An Improving Performance Action Plan (IPAP) template2 is
available on the AMC website.

Global rating (required only for the end-of-term assessment)

Assign a global rating for the rotation. In assigning this rating consider the RMO’s ability to practise safely,
work with increasing levels of responsibility, apply existing knowledge and skills, and learn new knowledge
and skills during the term.

Global rating

Satisfactory The RMO has met or exceeded performance expectations in the term

Borderline Further information, assessment and/or remediation may be required before deciding that the RMO has met
performance expectations

Unsatisfactory The RMO has not met performance expectations in the term

Please comment on the following:

Strengths

Areas for improvement

Supervisor Signature

Name (print clearly)

Page 6 of 8
Position
Director of Clinical Training

Name (print clearly)

Date

day Mo Year Signature

nth

RMO
Date
I (insert name)

confirm that I have discussed the above report with my

assessor and know that if I disagree with any points I Day Mo Year
may respond in writing to the Director of Clinical nth
Training within 14 days.
Director of Clinical Training comments
Signature

Date

Day Mo Year
nth

Return of form
Please forward to (contact person, department):
– Administration Officer,
Medical Education DX 465649 Medical Education Officer

Relevant documents Name (print clearly)

Relevant documents are available on the AMC
website http://www.amc.org.au/index.php/ar/psa
Good Medical Practice: A Code of Conduct for Doctors in Australia

2
Signature
Improving Performance Action Plan (IPAP) template

Date

Day Month Year

Page 7 of 8
1