ࡱ>  bjbjss 4d%GUU8q4Y] ] ] ] c$&|e(T3V3V3V3V3V3V3S68LV3%)A$"c$%)%)V3UU] ] +4).).).%)^U8] ] T3).%)T3).).f00] Pŧ[*)v~0@3A40q40,A9)0A900&A90h%)%)).%)%)%)%)%)V3V3).%)%)%)q4%)%)%)%)A9%)%)%)%)%)%)%)%)%) :  To be completed by the reviewers [Boxes will expand as you type] Surname of VMO  FORMTEXT      Given name(s)  FORMTEXT      Date  FORMTEXT      Primary qualifications  FORMTEXT      Fellowships (if applicable)  FORMTEXT      MPO number  FORMTEXT      Hospital(s)  FORMTEXT      Scope of Clinical Practice  FORMTEXT      Department (if appropriate)  FORMTEXT      Review conducted by:  FORMTEXT        FORMTEXT        The VMO should be assessed in terms of the categories set out in the following pages. The review should be undertaken within a month of the receipt of a Level 1 assessment form completed by the VMO, and be finalised after an interview with the VMO. At least two reviewers must undertake the review and participate in an initial interview they should include the supervisor/manager of the VMO (usually the relevant Head of Department) and, as appropriate, the relevant hospital Director of Medical Services, Divisional Director, or a medical administrator. The attached form should be finalised after the interview. As part of the Level 2 process, the VMO should nominate 3 referees from whom comments can be obtained by the reviewers on the matters dealt with in this form, using the separate form available for this purpose. The referees should include another medical practitioner from a different speciality, a non-medical person with whom the VMO works, and any other person able to comment on the work of the VMO. The reviewers should obtain written reports, or oral reports with the comments then recorded in writing, about those topics dealt with in this form on which they are in a position to comment. Where applicable and possible, the reviewers should also obtain aggregated data on feedback from medical students and junior medical staff concerning the teaching and supervision provided by the VMO, to inform them concerning the issues to be covered under Section 3 Teaching in this form. The review process as recorded in this form may be used in reaching decisions about reappointment of VMOs, and by selection panels in assessing comparative merit between applicants for VMO appointments. SUMMARY OF REVIEW OUTCOMES 1. Services Provided (i) Effective management/treatment of patients, including efficient discharge planning:PoorOutstandingRanked by assessor [insert a ( next to the number]:N/A 1 FORMCHECKBOX  2 FORMCHECKBOX  3 FORMCHECKBOX  4 FORMCHECKBOX  5 FORMCHECKBOX Comment [box will expand as you type]:  FORMTEXT       Any action required [box will expand as you type]:  FORMTEXT        (ii) Maintenance of clinical skills and expertise:Not being maintainedBeing maintainedRanked by assessor [insert a ( next to the number]:N/A 1 FORMCHECKBOX  2 FORMCHECKBOX  3 FORMCHECKBOX  4 FORMCHECKBOX  5 FORMCHECKBOX Comment [box will expand as you type]:  FORMTEXT       Any action required [box will expand as you type]:  FORMTEXT        (iii) Participation in clinical governance activities, such as departmental meetings, hospital committees:No participationExtensive participationRanked by assessor [insert a ( next to the number]:N/A 1 FORMCHECKBOX  2 FORMCHECKBOX  3 FORMCHECKBOX  4 FORMCHECKBOX  5 FORMCHECKBOX Comment [box will expand as you type]:  FORMTEXT       Any action required [box will expand as you type]:  FORMTEXT       (iv) Clinical outcomes (including any issues arising from IIMS reports):PoorExcellentRanked by assessor [insert a ( next to the number]:N/A 1 FORMCHECKBOX  2 FORMCHECKBOX  3 FORMCHECKBOX  4 FORMCHECKBOX  5 FORMCHECKBOX Comment [box will expand as you type]:  FORMTEXT       Any action required [box will expand as you type]:  FORMTEXT        (v) Maintenance of patient records:PoorEnsures accurate and comprehensive patient records, countersigns ward round entries and ensures quality of discharge summaries.Ranked by assessor [insert a ( next to the number]:N/A 1 FORMCHECKBOX  2 FORMCHECKBOX  3 FORMCHECKBOX  4 FORMCHECKBOX  5 FORMCHECKBOX Comment [box will expand as you type]:  FORMTEXT       Any action required [box will expand as you type]:  FORMTEXT        (vi) Effective communication with patients:Does not exhibit relevant skillsDevelops excellent rapport with patientsRanked by assessor [insert a ( next to the number]:N/A 1 FORMCHECKBOX  2 FORMCHECKBOX  3 FORMCHECKBOX  4 FORMCHECKBOX  5 FORMCHECKBOX Comment [box will expand as you type]:  FORMTEXT       Any action required [box will expand as you type]:  FORMTEXT        (vii) Collegiate and cooperative relations with other medical and non-medical staff:Does not exhibit relevant skillsEnjoys effective and harmonious relations with other staffRanked by assessor [insert a ( next to the number]:N/A 1 FORMCHECKBOX  2 FORMCHECKBOX  3 FORMCHECKBOX  4 FORMCHECKBOX  5 FORMCHECKBOX Comment [box will expand as you type]:  FORMTEXT       Any action required [box will expand as you type]:  FORMTEXT        (viii) Clinical supervision of junior medical staff Provides poor support and assistanceProvides excellent support and assistanceRanked by assessor [insert a ( next to the number]:N/A 1 FORMCHECKBOX  2 FORMCHECKBOX  3 FORMCHECKBOX  4 FORMCHECKBOX  5 FORMCHECKBOX Comment [box will expand as you type]:  FORMTEXT       Any action required [box will expand as you type]:  FORMTEXT        (ix) Participation in quality improvement activities:No participationExtensive participationRanked by assessor [insert a ( next to the number]:N/A 1 FORMCHECKBOX  2 FORMCHECKBOX  3 FORMCHECKBOX  4 FORMCHECKBOX  5 FORMCHECKBOX Comment [box will expand as you type]:  FORMTEXT       Any action required [box will expand as you type]:  FORMTEXT        2. 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Teaching  (xi) Contribution to the training and education of undergraduate medical or other health professional staff:No involvementSignificant contributionRanked by assessor [insert a ( next to the number]:N/A 1 FORMCHECKBOX  2 FORMCHECKBOX  3 FORMCHECKBOX  4 FORMCHECKBOX  5 FORMCHECKBOX Comment [box will expand as you type]:  FORMTEXT       Any action required [box will expand as you type]:  FORMTEXT        (xii) Contribution to post graduate medical education (including as shown by junior medical staff training reports):No involvementSignificant contributionRanked by assessor [insert a ( next to the number]:N/A 1 FORMCHECKBOX  2 FORMCHECKBOX  3 FORMCHECKBOX  4 FORMCHECKBOX  5 FORMCHECKBOX Comment [box will expand as you type]:  FORMTEXT       Any action required [box will expand as you type]:  FORMTEXT        4. Managerial/Administrative responsibilities  (xiii) Managerial/Administrative responsibilities:Limited effectivenessDemonstrates excellent skillsRanked by assessor [insert a ( next to the number]:N/A 1 FORMCHECKBOX  2 FORMCHECKBOX  3 FORMCHECKBOX  4 FORMCHECKBOX  5 FORMCHECKBOX  Comment [box will expand as you type]:  FORMTEXT       Any action required [box will expand as you type]:  FORMTEXT        5. Practicing in accordance with accepted professional standards (xiv) Matters concerning professional standing (it is the responsibility of the VMO to advise of any current orders or conditions on registration or any unresolved matters currently before the medical board or the HCCC. Any such matters must be recorded here):Comment [box will expand as you type]:  FORMTEXT       Any action required [box will expand as you type]:  FORMTEXT        6. Relationship with the Hospital/Organisation (xv) Relationship with the hospital/organisation, and agreed assistance/resources to facilitate the provision of services by the VMO:Comment [box will expand as you type]:  FORMTEXT       Any action required [box will expand as you type]:  FORMTEXT       7. Overall Conclusion  (xvi) Any significant issues not already covered, major areas of identified further action and overall conclusion:Comment [box will expand as you type]:  FORMTEXT        Signature of Reviewer and Date: Name and Title of Reviewer: Signature of Second Reviewer and Date: Name and Title of Second Reviewer:  Feedback should be provided to the VMO as soon as possible and preferably within 30 days of date of review Note A VMO who wishes to query or challenge any of the comments made by the reviewer is able, by applying in writing to the reviewer within one month of the date of receipt of this review, to request that a further review of those comments be undertaken by the relevant facility General Manager and Chair of the Medical Staff Council or their nominees.     2505 LEVEL 2 SPECIALIST VISITING MEDICAL OFFICER PERFORMANCE REVIEW FORM vd$IfgdY{kdI$$Ifl0#  t0$644 laytYzm ? }U"d$IfgdYwkdfJ$$Ifl#$  t 0$644 lap ytY"$&TVXtvxz|X\^r~pjhPmUmHnHujMhPmUhPmjhPmUhYhx9CJaJ hYhx9jLhPm5UjlLhPm5UjKhPm5UjKhPm5UjKhPm5U hPm5jhPm5UhYhx95+z|yyyd$IfgdYwkdTM$$Ifl#$  t 0$644 lap ytY\d$IfgdYhkdtN$$Ifl#$ t0$644 laytYrtv:>@JLhjlprǻӳף׳׳{vi{{vjURhPm5U hPm5jhPm5U jhYh?6:5hYh?6:CJaJhYh?6:5hYhPOr5hYhAO5hYhx95hYhx95CJaJhYhWo5CJaJhx9 hYhx9jhPmUmHnHujhPmUjNhPmU$dxx$IfgdYhkdgO$$Ifl#$ t0$644 laytY|d0dxx$If^`0gdYgdx9~kdO$$Ifl#$  t 0$644 l` ap ytYt$dxx$Ifa$gdYdxx$IfgdYhkdP$$Ifl#$ t0$644 laytY>vd$IfgdY{kd Q$$Ifl0#  t0$644 laytY>@2m ? }U"d$IfgdYwkdQ$$Ifl#$  t 0$644 lap ytY ,.024D~*,.8:@Bܵᛗ~ᛗs~ohWoj6VhPmUjhPmUmHnHujCUhPmUhPmjhPmUhYhx9CJaJ hYhx9j%ThPm5UjShPm5Uj=ShPm5U hPm5hYhx95jhPm5UjRhPm5U*24yyyd$IfgdYwkdT$$Ifl#$  t 0$644 lap ytY<>d$IfgdYhkdU$$Ifl#$ t0$644 laytY>@B,dxx$IfgdYhkdV$$Ifl#$ t0$644 laytYBDH(,.~8:<@B^`bfhкwjMZhPm5UjYhPm5UjeYhPm5UjXhPm5U hPm5jhPm5U jhYh?6:5hYh?6:CJaJhYh?6:5 hYhPOrhYh:m5hYh 5hYhAO5hYhPOr5*,.L~t$dxx$Ifa$gdYdxx$IfgdYhkd)W$$Ifl#$ t0$644 laytY~vd$IfgdY{kdW$$Ifl0#  t0$644 laytYm ? }U"d$IfgdYwkdGX$$Ifl#$  t 0$644 lap ytY(,.BDFPRXJLNPX DFXZøǪßǪڛڛ{shshYh?6:CJaJhYh?6:5hYhAO5hYhPOr5CJaJhYhWo5CJaJhPOrj\hPmUjhPmUmHnHuj[hPmUhPmjhPmUhYhPOrCJaJ hYhPOrhYhPOr5jhPm5UjZhPm5U',TVyyyd$IfgdYwkd5[$$Ifl#$  t 0$644 lap ytYVXd$IfgdYhkdU\$$Ifl#$ t0$644 laytYJdxx$IfgdYhkdH]$$Ifl#$ t0$644 laytYJLN|d0dxx$If^`0gdYgdPOr~kd]$$Ifl#$  t 0$644 l` ap ytYt$dxx$Ifa$gdYdxx$IfgdYhkdn^$$Ifl#$ t0$644 laytY vd$IfgdY{kd^$$Ifl0#  t0$644 laytYZ\^$&(VXZvxz|~öéÜÏÂ}ujbjhPmUhYhPOrCJaJhYhPm5 hPOr5jbhPm5UjahPm5UjahPm5Uj`hPm5Uj6`hPm5U hPm5jhPm5U hYhPOrhYhPOr5hYh?6:CJaJhYh?6:5 jhYh?6:5&|~mm ? }U"d$IfgdYwkd_$$Ifl#$  t 0$644 lap ytY~yyyd$IfgdYwkdzb$$Ifl#$  t 0$644 lap ytY"\`bvxz "2lprԲԲzoj0fhPmUhYhAO5hYhFS65CJaJhYh/V5CJaJhYhPOr5CJaJhYhWo5CJaJhPOrjdhPmUhYhPOrCJaJhYhPOr5 hYhPOrjhPmUmHnHujhPmUj$chPmUhPm+`d$IfgdYhkdc$$Ifl#$ t0$644 laytYdxx$IfgdYgdPOrhkdd$$Ifl#$ t0$644 laytY |d0dxx$If^`0gdYgdPOr~kd e$$Ifl#$  t 0$644 l` ap ytY "pd$IfgdYhkde$$Ifl#$ t0$644 laytY*,d$IfgdYhkdf$$Ifl#$ t0$644 laytY&(.02B|*,.8ǻӳ׳윑׳윆ǻӳ׳{jHlhPmUj/jhPmUj@d$IfgdYhkdk$$Ifl#$ t0$644 laytY8:BDHJdt "$,.R`tv|~$&VXќ𘔃ugh8;56]^JmH sH h656]^JmH sH !heRzheRz56]^JmH sH h8;hhYh.5 hYhq{Q hYhe hYhhhYhe5hYhq{Q5hYhV5hYhPOr5hYhh5 hYhThPmhPOr hYhPOrjhPmU&@BDFHd$IfgdYgdPOrhkdl$$Ifl#$ t0$644 laytY d$IfgdYhkd;m$$Iflp## t0644 laytY$&(*,d$IfgdYhkdm$$Iflp## t0644 laytY,.tvxz|d$IfgdYhkdQn$$Iflp## t0644 laytY|~XZddxx$IfgdYdhkdn$$Iflp## t0644 laytYXZbdfhVXdf$&(*,0268<>BJLNP\^`vǿǻη~u~u~u~u~qhi hz5CJ$aJ$h]ikhz5CJ$aJ$hzh,@hzCJaJhF|CJaJh hYhBEhYhBE5CJaJhYh5CJaJhBE56]^JmH sH (dfh$&(*.04wrwhaWUW dgd,@d dgdBEgd`7 dgdF>~kdKo$$Iflp##  t 0644 l` ap ytY 46:<@BLNPd $a$gd]ik$d<a$gd]ik$a$gd,@ dgd,@ 21h:p8$. 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