NOTES TO ASSIST IN THE COMPLETION OF STRUCTURED REFERENCE REPORT
Faculty of Radiologists
The Royal College of Surgeons in Ireland
Diagnostic Radiology
1. The Assessment Form is CONFIDENTIAL once completed, and must be handled accordingly.
2. The following guidelines are for referees completing the form:
A. Complete as fully as possible the candidate’s details in the first section, circling the appropriate period of
assessment.
B. Where more than one supervisor was involved with candidate a consensus opinion should be expressed on
the form.
C. Complete the main assessment by placing an ‘X’ in one box against each criterion. The following guidelines
should to be used when assessing each category.
D. Please note that, if requested by the candidate, a copy of this reference may be given to the candidate.
A. Clinical Skills Poor / Deficient Satisfactory Above Average / Excellent
History taking Incomplete, Inaccurate, Usually complete, orderly Precise, perceptive, ‘can spot
Poorly recorded. and systematic the rarity’
Physical Lacks basic skills Can elicit correct signs. Thorough, accurate. Knows and
Examination Recognises most elicits specialist signs
significant findings
Diagnostic Haphazard or inappropriate Orders laboratory and Very good awareness of most
Investigations ordering of diagnostic tests. imaging investigations appropriate and efficient
Unaware of significance of appropriately. diagnostic pathway.
appropriate testing.
Diagnostic Skills Fails to interpret and Competent clinician. Good Outstanding diagnostician.
synthesise symptoms, knowledge with an orderly Excellent clinical memory.
signs and investigations logical approach to
differential diagnosis.
Clinical Judgement Deficient assessments of Sound patient Outstanding clinician who is
patient status. Does not assessments. Recognises aware of his / her limits. Always
recognise own limitations. the sick patient. knows when to call for help.
Does not call for help.
Operative Skills Clumsy, rough with tissues. Competent. Handles Promises to develop into an
Totally lacking in self- tissues well excellent technical surgeon
confidence technically
Postoperative Uninterested. Fails to Conscientious. Good Excellent on wards. Notices
Management notice complications and awareness for problems early
act appropriately. Only complications. Knows
follows up patients when patients well.
pressed to do so.
B. Professional Poor / Deficient Satisfactory Above Average / Excellent
Development
Teaching Activities Uninterested and avoids Competent and Excellent enthusiastic teacher
teaching. Contributes little conscientious in teaching who inspires others.
to the education of others.
students or interns.
Clinical Audit Little interest in auditing Participates actively in Very good understanding of role
clinical activity. Poor regular audit. of audit. Plays active role in
knowledge of audit collection and storage of audit
process. data.
Presentations No interest in giving papers Keen to give presentations Fully researched original ideas.
or making presentations which are well illustrated Enthusiastic presenter. Answers
within the hospital or at and well delivered. questions lucidly.
clinical meetings.
Research Has neither inclination nor Keen to do research but Flare for original research and
ideas. Unable to carry out needs direction. ability to carry it out
“directed” projects. independently. Good grasp of
statistics and research methods.
C. Personal Skills Poor / Deficient Satisfactory Above Average / Excellent
Communication Does not communicate Good communicator. Pays great attention to
satisfactorily with patients, importance of good
relatives or other team communications skills. Regularly
members. seeks feedback that his / her
message has been understood.
Teamwork Poor team player. Works Good team player. Good understanding of team
alone. Does not contribute Understands importance roles of his / her role on team.
to team performance. of teamwork. Works harmoniously with all
other team members.
Leadership Very limited. ‘Switches Competent but lacks Outstanding team leader with
people off’. Colleagues and inspiration. Gives clear exceptional ability to motivate
other staff confused by his / instructions. others
her instructions
Self Awareness and Little or no understanding Aware of his / her Very secure person. Recognises
Insight of own limitations or strengths and own deficiencies and prepared
deficiencies. weaknesses. to make appropriate changes.
Motivation and Drive No inclination to organise Able to organise working Constantly pro-active, always
work. Needs to be ‘pushed’ routine without prepared to accept additional
constantly supervision. Looks for opportunities to advance.
opportunities to learn
Disposition and Sloppy in appearance and Good overall attitude. Highly motivated enthusiastic
Appearance work manner. Does not Presents himself / herself and ambitious.
inspire confidence in well.
others.
Management of Constantly disorganised. Manages priorities well in Very good handling of stress and
Stress and Workload Does not identify priorities. face of excessive workload. Prioritises
Always behind in workload. workloads. appropriately. Delegates or
seeks help when necessary.
Management of Falls apart at times of Remains calm and Handles crises situations very
Crises crises. Unable to deal organised at time of well. Calm demeanour. Inspires
satisfactorily with crises. other team members.
emergencies.
Reliability Unreliable, scatterbrained. Dependable. Does not Highly conscientious. Anticipates
Forgets to do things to the need reminding. problems.
possible detriment of Conscientious in patient
patients care
D. Relationships Poor / Deficient Satisfactory Above Average / Excellent
Medical Colleagues Fails to get on with seniors, Good rapport with Always willing to help even if
contemporaries or juniors. colleagues. Usually willing personally inconvenient. Able to
May even undermine them. to help in a crisis. Trusted, diffuse problems in the surgical
Refuses to help them out easy to work with. team. ‘An excellent colleague’.
Nursing & Treats them with disdain. Sound and professional Inspires enthusiasm.
Paramedical Staff Generates as opposed to yet approachable. Treats Exceptional communication
solving problems. Rude others with respect and is skills.
respected in return
Patients and Increases patient’s and Sound caring attitude. Can Inspires confidence. Establishes
Relatives. relatives anxieties. Rude. allay fears of patients and excellent rapport. Excellent
Patients do not want him / relatives. Takes time. communicator. Patients
her as their doctor. Bad Listens well. Explains well. delighted to be looked after by
listener & communicator Trusted by the patients him / her
and relatives.
TRAINING PROGRAMME IN DIAGNOSTIC RADIOLOGY
July 2019 Intake
Structured Reference Report
Faculty of Radiologists
The Royal College of Surgeons in Ireland
This is an important and official document, which will be used as part of the selection process for the training
programme in Diagnostic Radiology. Following completion you should forward it to the Faculty of Radiologists,
Royal College of Surgeons, RCSI House 123 St. Stephens Green Dublin 2.
Candidate name:
Referee Name
Hospital / Specialty:
Rotation Start Date: End Date:
Notes:
Complete the form by placing an ‘X’ in one box against each assessment. A “satisfactory” grade indicates that the
candidate performed according to reasonable expectations but was no better and no worse than average. The
majority of candidates would be expected to score “satisfactory”
Supervisors who award a “Poor” or “Excellent” grade should clarify why this grade is being awarded in the
overall comments section below
This form is accompanied by a list of grading descriptors to assist supervisors in grading the candidates.
When assessing candidates the supervisor should consider the candidate’s performance in all of the domains in
which he or she works, i.e. elective work on the wards, emergency work (on-call) in the Emergency Medicine
department, and work in the out-patients clinic, operating theatre, and specialist areas.
A. Clinical Skills
Satisfactor Above
Poor Deficient Excellent
y Average
History Taking
Physical Examination
Diagnostic Investigations (Lab /
Imaging)
Diagnostic Skills
Clinical Judgement
Operative Skills
Post-operative Management
B. Professional Development
Satisfactor Above
Poor Deficient Excellent
y Average
Teaching Activities
Clinical Audit
Presentations
Research
Satisfactor Above
C. Personal Skills Poor Deficient Excellent
y Average
Communication
Teamwork
Leadership
Self Awareness and Insight
Motivation and Drive
Disposition and Appearance
Management of Stress and Workload
Management of Crises
Reliability
Satisfactor Above
D. Relationships
Poor Deficient Excellent
y Average
Medical Colleagues
Nursing and Paramedical Staff
Patients and Relatives
Comments
Did this doctor perform well in his / her post with you? _____________________________________
Do you think he / she is suitable for a career in Radiology? ___________________________________
Has he / she any outstanding characteristics? ___________________________________________
Overall Comments:
________________________________________________________________________________
________________________________________________________________________________
______________________________________________________________________________
Final Assessment
Please indicate on scale of 1-5 your overall assessment of this trainee’s
suitability for Training Programme in Diagnostic Radiology
(5 = strongest possible support; 1 = very little support)
Signature: ______________________________________________________
Date: ____________________________________________
Please return completed form with Application by 2nd November 2018
Faculty of Radiologists, Royal College of Surgeons in Ireland,
RCSI House, 123 St. Stephen’s Green, Dublin 2
Any attempt to provide misleading or false information to improve your score in shortlisting or interview
will result in automatic disqualification.