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NCHD Reference Form for Paediatrics

The document is a reference form for Dr. Murtada Awad Ibraheem Hussien, who is applying for a Registrar position in Paediatrics at Our Lady of Lourdes Hospital. It includes sections for evaluating the applicant's performance in various areas such as knowledge, technical skills, attitude, relationships with staff, and communication skills. The referee, Dr. Ismail Elsayed Elmarasi, provides feedback and indicates a willingness to recommend the applicant for the position.
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0% found this document useful (0 votes)
7 views4 pages

NCHD Reference Form for Paediatrics

The document is a reference form for Dr. Murtada Awad Ibraheem Hussien, who is applying for a Registrar position in Paediatrics at Our Lady of Lourdes Hospital. It includes sections for evaluating the applicant's performance in various areas such as knowledge, technical skills, attitude, relationships with staff, and communication skills. The referee, Dr. Ismail Elsayed Elmarasi, provides feedback and indicates a willingness to recommend the applicant for the position.
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Medical Manpower Department,

Our Lady of Lourdes Hospital,


Drogheda,
Co, Louth.
Phone: 041 - 9874682
Fax: 041 - 9874722

REFERENCE FORM FOR NCHD POSITION

URGENT PLEASE RESPOND BY RETURN

TO EMAIL: [Link]@[Link]

Applicant’s Name: Dr Murtada Awad Ibraheem Hussien

For the role of: Registrar in Paediatrics

Competition Reference number:

(i)How long have you known the applicant and in what capacity?

From February 2023 To August 2024


Consultant- immediate supervisor 

Educational Supervisor 

Clinical Director 

Other (please specify)  …………………………………………

(ii)What was the applicant’s job title: Resident Paediatrician


(iii) Dates of employment: February 2023
Please rate the applicant’s performance in the following areas, by reference to the grade at which
the applicant was employed:

(Please tick)

1) Knowledge/Experience
a. Very able, comprehensive knowledge of speciality 
b. Good all round medical knowledge 
c. Satisfactory with areas of improvement needed (Key areas of medicine well known but not details
of the specialty) 
d. Adequate with some gaps in knowledge 
e. Unsatisfactory- Large areas of inexperience 

Comments: …………………………………………………………………………………

Medical Manpower Department October 2021 pg. 1


2) Technical Skills
a. Able and highly skilled with relevant/required practical procedures 
b. Satisfactory - capable with most practical procedures 
c. Satisfactory - Some gaps in performance of procedures 
d. Significant area of concern- Poor practically 

Comments: ………………………………………………………………………………

3) Attitude to patients and family


a. Usually very thoughtful and caring 
b. Generally satisfactory 
c. Satisfactory but occasionally failing to think of their needs 
d. Unsatisfactory 

Comments: …………………………………………………………………………………

4) Relationships with other staff


a. Satisfactory, generally gets on well with most people 
b. Satisfactory, an area of strength and professional in dealing with others 
c. Adequate and only occasionally conflicts with other colleagues 
d. Substantial area of concern - upsets others/does not work as one of a team 

Comments: …………………………………………………………………………………

5) Response to stress

a. Unsatisfactory -Exhibits uncertainty in stressful situations/ uncertainty in referral 


b. Satisfactory, an area of strength and manages patients well and calmly seeks advice regarding
problems promptly and appropriately having thought them through 
c. Adequate, however sometimes uncertain when to discuss potential problems with senior
colleagues 
d. Unsatisfactory 

Comments: …………………………………………………………………………………

6) Note keeping

a. Unsatisfactory - Inconsistent or poor note keeping 


b. Exemplary Always keeps clear, concise problem-orientated notes 
c. Satisfactory -Usually keeps well prepared problem-orientated notes 

7) Organisational Skills
a. Effective 
b. Satisfactory 
c. Significant area of concern 

Medical Manpower Department October 2021 pg. 2


8) Audit
a. Participates actively in audit 
b. Satisfactory Participation 
c. Unsure as there were service pressures so cannot assess 
d. Will participate but did not demonstrate motivation 
e. Unsatisfactory participation 

9) Communication Skills
a. Excellent written and verbal communication 
b. Satisfactory 
c. Satisfactory although there were some gaps in understanding 
d. Unsatisfactory- Difficulties in communications (written or) verbal 

10) Sickness Absence: Did you have any cause for concern about the applicant’s level of sickness
absences – this? (Can be completed by Medical HR or referee)

Yes  No 

If yes please specify:


………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………
11) Is the applicant currently subject to any work performance or active disciplinary investigations or
procedures, formal or otherwise during their time with you (including proceedings instigated by the
IMC/ anybody governing medical professionals)? (Can be completed by Medical HR or referee)
Yes  No 

If yes please describe:

………………………………………………………………………………………………………………………………………………………

12) Would you:


 Re-employ the applicant Yes  No 
 recommend him/her to another employer Yes  No 
 recommend him/her to Lady of Lordes Hospital , for this post Yes  No 

13) General Comments:

Updating general knowledge, cooperative with his colleagues and shows respect towards his seniors.

Medical Manpower Department October 2021 pg. 3


Signed: Dr. Ismail

Print Name: Ismail Elsayed Elmarasi

Title: Specialist of paediatrics

Contact details: Email: drelmarasi@[Link]

Date: 25/8/2024 Official Stamp:

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS FORM.


PLEASE RETURN TO THE MEDICAL ADMINISTRATION DEPARTMENT AT YOUR EARLIEST
POSSIBLE CONVENIENCE

Medical Manpower Department October 2021 pg. 4

Common questions

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The reference form evaluates the applicant's organizational skills by categorizing them into effective, satisfactory, or being a significant area of concern. The criteria consider the applicant's ability to effectively manage tasks and responsibilities within their role .

A 'No' answer to recommending the applicant for re-employment or another position suggests the referrer may have reservations about the applicant's performance or behavior, potentially impacting the applicant's future employment opportunities .

The main criteria used to evaluate a paediatrician's performance include Knowledge/Experience, Technical Skills, Attitude to patients and family, Relationships with other staff, Response to stress, Note keeping, Organisational Skills, Audit participation, Communication Skills, Sickness Absence, and whether the applicant is subject to any work performance or disciplinary investigations .

Communication skills are assessed by evaluating the applicant's written and verbal communication as excellent, satisfactory, satisfactory with some gaps, or unsatisfactory. Poor evaluation, marked as unsatisfactory, indicates difficulties in both written and verbal communication, which could hinder effective collaboration and patient care .

The levels of proficiency in technical skills noted include being highly skilled, satisfactory with most procedures, satisfactory with some gaps, and significant area of concern if there is poor practical performance in required procedures .

The reference form evaluates the applicant's attitude towards patients and families by classifying it as usually very thoughtful, generally satisfactory, satisfactory but occasionally lacking, or unsatisfactory. This assessment helps gauge the physician's empathy, communication proficiency, and ability to fulfill patient and family needs, which are essential for effective patient care .

A satisfactory note-keeping ability involves consistently maintaining well-prepared, problem-oriented notes. This ability is crucial for ensuring clear and effective communication among medical staff, accuracy in patient records, and facilitating continuity of care .

Yes, the reference form includes provision for assessing whether the applicant is under any current work performance investigations or disciplinary procedures, formal or otherwise. A positive indication of such investigations can affect the applicant's reputation, impact career progression, and raise concerns about their professional conduct .

A supervisor might be unsure about an applicant's participation in audits due to service pressures that prevent a clear assessment of the applicant's involvement. The options for audit participation include active participation, satisfactory participation, unsure due to service pressures, and unsatisfactory participation .

Performance regarding 'Response to stress' is classified as unsatisfactory or satisfactory. A satisfactory performance is described as managing patients well, calmly seeking advice regarding problems promptly and appropriately after thinking them through. Unsatisfactory performance involves uncertainty in stressful situations or uncertainty in referral .

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