DB-MSF Colleague Feedback Questionnaire

DB-MSF Colleague Feedback Questionnaire

"*" indicates required fields

Licensed doctors are expected to seek feedback from colleagues and review and act upon that feedback where appropriate.
The purpose of this exercise is to provide doctors with information about their work through the eyes of those they work with, and is intended to help inform their further development.

Please do not write your name on this questionnaire. No one will be identified. Emails will be received by HR and only combined results of the questionnaire will be shared with the Practitioner.

Please answer all the questions. If you feel you cannot answer any question, please tick ‘Don’t know’. 


Complete Questionnaire

1. Clinical Knowledge*
2. Diagnosis*
3. Clinical decision making*
4. Treatment (including practical procedures)*
5. Prescribing*
6. Medical record keeping*
7. Recognising and working within limitations*
8. Keeping knowledge and skills up to date*
9. Reviewing and reflecting on own performance*
10. Teaching (students, trainees, others)*
11. Supervising colleagues*
12. Commitment to care and wellbeing of patients*
13. Communication with patients and relatives*
14. Working effectively with colleagues (team player)*
15. Effective time management*
16. This doctor respects patient confidentiality*
17. This doctor is honest and trustworthy*
18. This doctor’s performance is not impaired by ill health*
19. This doctor is fit to practise medicine*

The next questions will give us some information about position of the person took part in the survey

What is your role?*
How recently have you been familiar with this doctor’s practice?*
How often do you have contact with the doctor?*
Thank you for your input.
Thank you for completing this questionnaire. Please ensure all your answers are correct and complete, then press submit.