UCL MEDICAL SCHOOL
Research Department of Primary Care and Population Health
T U TO R
P R O F I L E
1. PERSONAL DETAILS
Name
Practice Name
Address
Telephone No.
Date of Birth
Gender
Email Address
/
Female
/ 19
Medical School
Year of Qualification
Male
GMC No.
Current Post
Year of entry in to General Practice
Full-time Principal
Part-time Principal
GP Assistant / Non-Principal
Other (please specify)
2. QUALIFICATIONS, AWARDS & ACHIEVEMENTS
Medical
Qualifications
and Dates
MBBS
MRCGP
MRCP
FRCGP
DCH/DCCH
DRCOG
Other (please specify)
Teaching
Qualifications
and Awards
Certificate in Medical Education
Member or Associate of ILTHE/HE Academy
UCL Distinguished Teacher Award
Other (please specify)
3. TEACHING EXPERIENCE
Undergraduate
Have you taught medical students in the past?
Past
Yes (if YES specify below)
Current
No
Courses
Community Placements (Years 1 and 2)
Professional Development Spine (PDS)
Introductory Course in Clinical Methods (ICCM)
Care of the Older Person (COOP)
Medicine in the community (MIC)
Core General Practice 1 (Year 4)
Indicate what courses you
have taught or you are
currently teaching
(please tick all that apply)
Child Health
Dermatology
Mental Health
Women’s Health
Core General Practice 2 (Year 5)
Special Study Modules (SSMs)
Other (please specify including other medical schools)
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Postgraduate
Indicate your Educational
experience at Postgraduate
level
GP Trainer
GP Associate Trainer
Course Organiser
PRHO training
SHO training
Registrar training
Other (please specify)
Other
List any other teaching
experience you consider
relevant. e.g. teaching
members of staff etc.
4. TEACHER TRAINING
Formal teacher training
programmes at UCL or
other institutions
(please tick all that apply)
Attendance and training at
the department of Primary
Care in the past year
(please tick all that apply]
TIPS I – Planning teaching
Year
TIPS II – Bedside teaching
Year
TIPS III – Presentation Skills
Year
TIPS IV – Communication skills
Year
PG Trainers or Teaching Teachers Course
Year
Other (please specify)
Year
New tutor course induction(s)
Annual training days/Workshops/Updates
Annual GP Tutor Conference
Clinical Teaching Fellows Support Group
5. DEVELOPMENT OF TEACHING
Departmental involvement:
Are you involved in any of the
following areas?
(please tick all that apply)
Peer Observation:
Have you undergone peer
observation of your teaching?
How useful do you find students’
evaluation of your teaching?
In house teaching (Lecturers, seminars communication skills etc.)
Medical School examinations/assessments
Date:
/
/
Observer:
Very Useful
1
Useless
2
3
(please circle)
4
Other Achievements:
Please mention any that you feel
are relevant
e.g. publications/research etc.
This information will be entered onto an Intradepartmental database. Please advise us of any important
changes during the year. We will contact you annually in August/September for updates on this data.
Please return to:
Ms Rushmi Pelpola
Research Department of Primary Care and Population Health
UCL Medical School, Rowland Hill Street, London NW3 2PF
Email: r.pelpola@ucl.ac.uk Tel: 020 7472 6449 Fax: 020 7472 6871
…Thank you for taking the time to complete this form in full…
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