1. Learner's details

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14% of survey complete.

This form was designed with Supervisor consultation during Compass 2013 and GPET 2013. It is designed to aid Supervisors / Supervision teams in communicating concerns about a Registrar to NTGPE staff. We invite you to use this tool and also encourage your feedback. Completed forms will be referred to the Registrar's Training Advice Team who will then follow up as appropriate.

GP Registrar Name

Question Title

* 1. GP Registrar Name

Training Term (eg. GPT/PRRT 2)

Question Title

* 2. Training Term (eg. GPT/PRRT 2)

Supervisor Name

Question Title

* 3. Supervisor Name

Training Post name

Question Title

* 4. Training Post name

This report

Question Title

* 5. This report

What is the main issue that concerns you about this learner?

Question Title

* 6. What is the main issue that concerns you about this learner?

Are there any other specific issues that concern you?
Eg professionalism, clinical knowledge, ethics, personal health and well being, cultural issues...

Question Title

* 7. Are there any other specific issues that concern you?
Eg professionalism, clinical knowledge, ethics, personal health and well being, cultural issues...

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