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Form A -Multi Source Feedback(MSF) - Information of Feedback givers

1.Postgraduate Institute of Medicine
University of Colombo

Instructions:

  • Please use this form to submit 15 nominees as per the guidelines to provide you with feedback. This will allow you to receive feedback from at least 12 feedback givers.
  • You should select the nominees (feedback givers) in consultation with your trainer and with his or her agreement.
  • Please ensure that all categories of staff are included in the nominees list (Eg: Consultants, Senior Registrars, Registrars, SHO's, Nursing officers, Medical Students, Pupil Nurses, Physiotherapists, Pharmacists, Labour Room Midwives, Technicians etc. as relevant)
  • If a nominee is able to provide you online feedback (e.g. if the nominee has a valid email address and is conversant in the use of a smart device/computer), you should provide his or her email address.
  • Please ensure that the email addresses provided are valid and functioning. Additionally, kindly make sure that all email addresses are typed correctly without any spelling errors. Please avoid adding spaces within email addresses and ensure that dots (.) are used correctly instead of commas (,), as incorrect entries may result in the Your MSF form not being received to that feedback providers.
  • You should provide this list to the Medical Education Resource Centre (MERC) of the PGIM before the deadline (as designated by the Board of Study) of submitting the MSF. (All trainees at MD level should submit MSF forms at least twice - Once during pre-MD period and once during the post-MD period - during their training unless otherwise deemed necessary by the relevant Board of Study.)


Trainee detail(Required.)
Nominees as feedback giver
1. Feedback giver #1(Required.)
2. Feedback giver #2(Required.)
3. Feedback giver#3(Required.)
4. Feedback giver#4(Required.)
5. Feedback giver#5(Required.)
6. Feedback giver#6(Required.)
7. Feedback giver#7(Required.)
8. Feedback giver#8(Required.)
9. Feedback giver#9(Required.)
10. Feedback giver # 10(Required.)
11. Feedback giver #11(Required.)
12. Feedback giver #12(Required.)
13. Feedback giver #13(Required.)
14. Feedback giver #14(Required.)
15. Feedback giver #15(Required.)