End of Term Assessment Form
End of Term Assessment Form
End of Term Assessment Form
From
JMO Surname: D D M M Y Y Y Y
(dd/mm/yyyy):
To
JMO First Name: D D M M Y Y Y Y
(dd/mm/yyyy):
AHPRA
M E D Term name:
registration no.
Organisation
and Department /
Unit where term
undertaken:
Page 1 of 6
Domain 1: Science and scholarship – The JMO as scientist and scholar
1.1 Knowledge: Consolidate, expand and apply knowledge JMO and/or Supervisor Comments on Domain 1
of the aetiology, pathology, clinical features, natural history
and prognosis of common and important presentations at all
stages of life.
JMO Supervisor
Rating Rating Description Not observed
4 4
Applies sound knowledge to
3 3 patient care.
2 2
2.1 Patient safety: Place the needs and safety of patients at the 2.2 Communication: Communicate clearly, sensitively and
centre of the care process. Demonstrate safety skills including effectively with patients, their family/carers, doctors and other
effective clinical handover, graded assertiveness, delegation health professionals.
and escalation, infection control, and adverse event reporting.
JMO Supervisor JMO Supervisor
Rating Rating Description Not observed Rating Rating Description Not observed
4 4 4 4
Demonstrates most aspects of safe Communicates effectively in routine
3 3 patient care. 3 3 situations.
2 2 2 2
2.3 Patient assessment: Perform and document a patient 2.4 Investigations: Arrange common, relevant and cost-effective
assessment - incorporating a problem focused medical history investigations, and interpret their results accurately.
with a relevant physical examination and generate a valid
differential diagnosis.
JMO Supervisor JMO Supervisor
Rating Rating Description Not observed Rating Rating Description Not observed
4 4 4 4
Performs and documents focused Arranges appropriate investigations
3 3 patient assessments for routine 3 3 and requires some guidance on
patients. interpretation.
2 2 2 2
Performs unfocused or incomplete
Arranges inappropriate investigations
1 1 patient assessments and/or 1 1 and/or interprets incorrectly.
documentation.
Page 2 of 6
Domain 2: Clinical practice – The JMO as practitioner (continued)
2.5 Procedures: Safely perform a range of common procedural 2.6 Patient management: Make evidence-based management
skills required for work as an JMO. decisions in conjunction with patients and others in the
healthcare team.
JMO Supervisor JMO Supervisor
Rating Rating Description Not observed Rating Rating Description Not observed
4 4 4 4
Performs most common procedures in
Applies evidence, protocols and
3 3 a technically safe and effective manner 3 3 guidelines to manage routine patients.
on routine patients.
2 2 2 2
Performs common procedures with
Does not apply evidence, protocols
1 1 limited technical proficiency and 1 1 and guidelines in patient management.
sensitivity to patients.
2.7 Prescribing: Prescribe medications safely, effectively and 2.8 Emergency care: Recognise and assess deteriorating and
economically, including fluid, electrolytes, blood products critically unwell patients who require immediate care. Perform
and selected inhalational agents. basic emergency and life support procedures, including caring
for the unconscious patient and performing cardiopulmonary
resuscitation.
JMO Supervisor JMO Supervisor
Rating Rating Description Not observed Rating Rating Description Not observed
4 4 4 4
Identifies deteriorating or critically
Prescribes safely and adheres to
unwell patients, initiates basic
3 3 relevant protocols in most situations 3 3 management and seeks appropriate
and seeks assistance when needed.
assistance.
2 2 2 2
Does not identify deteriorating or
critically unwell patients or cannot
1 1 Makes frequent prescribing errors. 1 1 initiate basic management correctly or
does not seek appropriate assistance.
2.9 Information management: Retrieve, interpret and record JMO and/or Supervisor Comments on Domain 2
information effectively in clinical data systems (both paper
and electronic).
JMO Supervisor
Rating Rating Description Not observed
4 4
Is consistent in recording information
in clinical data systems with
3 3 appropriate levels of detail and
timeliness.
2 2
Does not record information in clinical
1 1 data systems in an effective or timely
manner.
Page 3 of 6
Domain 3 – Health and society – The JMO as a health advocate
3.1 Population health: Apply knowledge of population health, 3.2 Aboriginal and Torres Strait Islander health: Apply
including issues relating to health inequities and inequalities; knowledge of the culture, spirituality and relationship to land
diversity of cultural, spiritual and community values; and socio- of Aboriginal and Torres Strait Islander peoples, to clinical
economic and physical environment factors. practice and advocacy.
JMO Supervisor JMO Supervisor
Rating Rating Description Not observed Rating Rating Description Not observed
4 4 4 4
Considers the health needs of different Practises cultural safety for Aboriginal
3 3 patient groups in patient care. 3 3 and Torres Strait Islander peoples.
2 2 2 2
Disregards cultural safety for
Does not recognise the health needs of
1 1 1 1 Aboriginal and Torres Strait Islander
different patient groups in patient care.
peoples.
3.3 Comorbidities: Demonstrate ability to screen patients 3.4 Quality assurance: Participate in quality assurance, quality
for common diseases, provide care for common chronic improvement, risk management processes, and incident
conditions, and effectively discuss healthcare behaviours reporting.
with patients.
JMO Supervisor JMO Supervisor
Rating Rating Description Not observed Rating Rating Description Not observed
4 4 4 4
Identifies common comorbidities and Participates in quality improvement
3 3 initiates satisfactory management. 3 3 activities and incident reporting.
2 2 2 2
Disregards the potential for Does not participate in quality
1 1 comorbidities and/or is unable to 1 1 improvement activities and fails to
initiate management. report incidents.
4 4
Behaves in a professional manner and
3 3 occasionally needs assistance when
under stress.
2 2
Behaves in a manner that demonstrates
1 1 disregard for professional standards.
Page 4 of 6
Domain 4 – Professionalism and leadership – The JMO as a professional and leader (continued)
4.2 Self-management: Optimise their personal health and 4.3 Self-education: Self-evaluate their professional practice,
wellbeing, including responding to fatigue, managing stress demonstrate lifelong learning behaviours, and participate in
and adhering to infection control to mitigate health risks of educating colleagues.
professional practice.
JMO Supervisor JMO Supervisor
Rating Rating Description Not observed Rating Rating Description Not observed
4 4 4 4
Manages the impact of work on Is able to self-evaluate and articulate
3 3 personal health and wellbeing. 3 3 personal learning goals.
2 2 2 2
Demonstrates impaired professional
Lacks insight into learning needs and
1 1 performance or other evidence of poor 1 1 does not seek or act on feedback.
self-care.
4.4 Clinical responsibility: Take increasing responsibility for 4.5 Teamwork: Respect the roles and expertise of other
patient care while recognising the limits of their own expertise healthcare professionals, learn and work effectively as a
and involving other professionals as needed to contribute to member or leader of an inter-professional team, and make
patient care. appropriate referrals.
JMO Supervisor JMO Supervisor
Rating Rating Description Not observed Rating Rating Description Not observed
4 4 4 4
Demonstrates initiative and takes Works effectively as part of the inter-
responsibility within the limits of 3 3 professional team.
3 3
expertise.
2 2
2 2
Works in a way that disrupts effective
Lacks insight into limitations and 1 1 functioning of the inter-professional
1 1 requires continued close supervision. team.
4.6 Time management: Effectively manage time and workload JMO and/or Supervisor Comments on Domain 4
demands, be punctual and show ability to prioritise workload
to manage patient outcomes and health service functions.
JMO Supervisor
Rating Rating Description Not observed
4 4
Effective management and prioritisation
3 3 of most tasks and may need assistance
during very busy times.
2 2
Unable to manage and prioritise tasks
1 1 in a timely manner resulting in task
build-up.
Page 5 of 6
Global rating
Assign a global rating of progress towards completion of internship or prevocational training. In assigning
this rating consider the JMO’s ability to practise safely, work with increasing levels of responsibility, apply
existing knowledge and skills, and learn new knowledge and skills during the term.
Global rating
£ Satisfactory The JMO has met or exceeded performance expectations in the term.
Further information, assessment and/or remediation may be required before deciding that the JMO
£ Borderline has met performance expectations.
£ Unsatisfactory The JMO has not met performance expectations in the term.
Signature Signature
Position Date
DPET comments
Day Month Year
Junior Medical Officer
I (insert name)
confirm that I have discussed the above report with my
assessor and know that if I disagree with any points I Return of form
may respond in writing to the DPET within 14 days. Please forward to (contact person, department):
Signature
Relevant documents
Relevant documents are available on the links below:
Date 1
Intern training – Assessing and certifying completion
2
Intern training – Intern outcome statements
3
Good Medical Practice: A Code of Conduct for Doctors in Australia
Day Month Year 4
Improving Performance Action Plan (IPAP) template
Page 6 of 6