GMC Self-assessment questionnaire

Self assessment questionnairefor Dr ________________________________________________________Licensed doctors are expected to seek feedback from colleagues and patients and review and act upon that feedback whereappropriate.This self-assessment will supplement the information obtained from the patient and colleague surveys.This self-assessment questionnaire will supplement the information obtained from the colleague and patient questionnairesand should be used for your own reflection.Please answer all the questions. If you feel you cannot answer any question, please tick ‘Don’t know’.Please mark the box like thischoice.3 with a ball point pen. If you change your mind just cross out your old response and make your newPlease write today’s date here: / /1 Please rate yourself in each of the following areas by ticking one box along each linePoor Less than Satisfactory Good Very Don’tsatisfactory good knowabcdefghijklmnoClinical knowledgeDiagnosisClinical decision makingTreatment (including practical procedures)PrescribingMedical record keepingRecognising and workingwithin limitationsKeeping knowledge andskills up to dateReviewing and reflecting onown performanceTeaching (students, trainees, others)Supervising colleaguesCommitment to care andwellbeing of patientsCommunication withpatients and relativesWorking effectivelywith colleaguesEffective time management

2 Does your current role include direct consultations with patients?Yes, frequently Yes, infrequently or occasionally NoIf ‘yes’, please move on to Questions 3a to 3g. If ‘no’, please move on to Question 4.3 Please rate how good you feel you are at each of the following by ticking one box along each line.Poor Less than Satisfactory Good Very good Does notsatisfactoryapplyabcdefgBeing polite to patientsMaking patients feel at easeListening to patientsAssessing patients’ medical conditionExplaining patients’ conditionand treatmentInvolving patients in decisions abouttheir treatmentProviding or arranging treatmentfor patients4 Please decide how far you agree with the following statements by ticking one box along each line.Strongly Disagree Neutral Agree Strongly Does notdisagree agree applyabcI respect patient confidentialityI am honest and trustworthyMy performance is not impairedby ill health5 I am fit to practise medicine Yes No Don’t know6 Please add any other comments you want to make about your own performance.The GMC is a charity registered in England and Wales (1089278) and Scotland SCO37750)