University of Sydney
Mid-Placement Review
Placement Information
Name of Trainee
Placement
Setting
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Name of
Supervisor
Placement
Type
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Secondary
Supervisor
Placement
Number
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Placement
Agency
Start date of
placement Click here to enter a date.
Placement days
Date of
review
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Hours of patient contact on this placement to date:
TOTAL number of patient contact hours
across all placements:
Hours of supervision on this placement to date:
TOTAL number of supervision hours across
all placements:
Overall number of hours on this placement to
date:
TOTAL number of overall hours across all
placements:
STANDARD OF EVALUATION
A competent clinical psychologist is able to expertly assess, diagnose, formulate, apply evidence-based treatments, and
evaluate therapeutic outcomes for those suffering from complex mental health disorders. This work must be conducted
within a legal, ethical and culturally sensitive framework by practitioners who demonstrate the personal qualities and
values suited to professional practice with clinically complex presentations.
This form evaluates the development of the competencies required for practice as a clinical psychologist. It evaluates the
application of knowledge to professional clinical practice in two primary competency areas: skills and personal capacities,
as evidenced in their application in clinical placements. Each competency is built on a staged development rating, with
Stage 4 denoting competency as new graduate from a Master level clinical psychology program. Each progressive Stage
assumes ongoing competency of the lower Stage.
Placements in which new populations are seen may see the trainee reverting to earlier stages of training in some areas,
but progress over the placement through the stages to competency (e.g. Outcome Evaluation)
The form may be completed by a supervisor independent of the student, but a collaborative evaluation in which feedback
can be discussed is recommended where possible. Ratings are tied to evidence of the demonstration of each
competency.
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SELF APPRAISAL BY TRAINEE: Give your own views about your learning on this placement. Identify the areas where
you feel you have demonstrated significant development, the areas in which you have been challenged, and the areas
that you need to develop more strongly to reach competency.
TRAINEE’S SELF-EVALUATION
AREAS OF STRONGEST DEVELOPMENT ON THIS PLACEMENT:
AREAS OF GREATEST CHALLENGE ON THIS PLACEMENT:
AREAS FOR FURTHER DEVELOPMENT:
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THE SUPERVISOR: Your role is to assess trainees and act as sound gate-keepers to the profession. You are required to
itemise any concerns you have about the trainee’s suitability for clinical practice, slow progress, or specific areas where
development is required.
COMPETENCIES - Skills
Assessment:
Stage 1:
Assesses straightforward presentations, such as anxiety and depression, following an externally cued semistructured biopsychosocial interview schedule over two sessions. Identifies significant relevant factors to explore
in greater depth according to individual presentation.
Stage 2:
Assesses straightforward presentations with formulation commenced within two sessions. Balances appropriate
breadth and depth of questioning through brief screening for impacting factors to selection and exploration of
relevant factors with greater depth. Generates hypotheses related to the contributing impact of these factors.
Stage 3:
Completes an assessment of straightforward presentations within a single session, with sound depth and
breadth, identifying individual issues of relevance and generating hypotheses in relation to impacting factors,
which are shared and tested with the individual. More complex cases take longer
Stage 4:
Assesses complex presentations using an internalised, flexible, semi-structured interview schedule, generating
hypotheses, and testing these via mini-formulations, with efficiency and focus adapted to the individual.
Stage 1
Left click and hold on the arrow
Stage 2
Stage 3
Stage 4
to move it to the place on the slider you wish to rate.
Comment (indicate via initials a case in which this skill level was demonstrated):
Diagnosis:
3
Stage 1:
Assesses criteria and differentiates straightforward anxiety and depressive disorders with reference to an
established taxonomy of disorders, such as the current DSM or ICD. Describes the usefulness and limitations of
diagnostic systems.
Stage 2:
Assesses criteria and differentiates straightforward anxiety and depressive disorders with some internalised
knowledge of an established taxonomy. Differentiates and diagnoses less familiar, discrete, more severe
presentations (e.g. bipolar disorder, schizophrenia, borderline personality disorder) with reference to the
established taxonomy of choice.
Stage 3:
Applies internalized knowledge of straightforward and singular complex diagnoses and is developing a working
application of more complex presentations, such as personality disorders, dual diagnoses incorporating drug and
alcohol disorders, and differential diagnoses.
Stage 4:
Identifies, assesses, differentiates and accurately diagnoses complex and unusual presentations. Describes
highly complex issues and weighs complex differential diagnoses.
Stage 1
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Stage 2
Stage 3
Stage 4
to move it to the place on the slider you wish to rate.
Comment (indicate via initials a case in which this skill level was demonstrated):
4
Formulation:
Stage 1:
Identifies biopsychosocial background factors, maintaining factors, and triggering events for straightforward
presentations, such as various anxiety and depressive disorders, according to a specific model. Develops these
formulations collaboratively in a diagrammatical model with the individual.
Stage 2:
Develops diagrammatical formulations and writes a descriptive formulation that explains the mechanisms through
which background factors influence development of disorders and how maintaining factors develop for the
individual as coping mechanisms for more complex problems. Applies to clinical work the integration of theoretical
models of development and maintenance of disorders with specific unique personal factors relevant for the
individual for more specific complex problems (e.g. bipolar disorder, schizophrenia, borderline personality
disorder).
Stage 3:
Applies to clinical work the integration of the theoretical and individual mechanisms of development and
expression of the patient’s coping strategies that lead to and maintain their difficulties in the development,
contribution and maintenance of more complex problems (e.g. personality disorders, dual diagnoses
incorporating drug and alcohol disorders, and differential diagnoses). Describes the contribution of more complex
factors, such as religious or cultural beliefs that impact problem development and maintenance.
Stage 4:
Applies to clinical work a sophisticated personalized understanding of the mechanisms of development,
maintenance and triggers of an individual’s problems when unusual and complex from multiple perspectives.
Communicates this understanding in a clear manner that makes sense of the complexities and individual factors
and increases understanding for the patient.
Stage 1
Left click and hold on the arrow
Stage 2
Stage 3
Stage 4
to move it to the place on the slider you wish to rate.
Comment (indicate via initials a case in which this skill level was demonstrated):
5
Treatment:
Stage 1:
Plans evidence-based, formulation-driven, goal directed treatment using the primary learned model to
straightforward problems, such as anxiety and depression, following a specific primary model (e.g. CBT) of
therapy. Applies sound skills to straightforward problems and demonstrates development of more advanced
skills in the primary model.
Stage 2:
Applies advanced skills in primary model flexibly and responsively to more severe presentations of straight
forward problems. Applies a formulation driven selection of new skills and approaches for specific individuals with
more complex problems (e.g. DBT skills). Identifies and addresses factors contributing to problems (e.g. beliefs,
themes, meanings, dynamics, and schemas) as they arise in session.
Stage 3:
Uses formulation to guide the appropriate choice of treatment and demonstrates advanced skills and creativity in
the application of treatment in response to the individual’s experience. Demonstrates understanding of the
limitations of all models of therapy. Addresses contributing factors as they arise in within session. Identifies
complex interactions of belief systems, such as religious, cultural and social beliefs.
Stage 4:
Flexibly and responsively applies formulation driven understanding and ensuing models of evidence-based
treatments (e.g. Schema Therapy, DBT, TFT etc.) for complex presentations, adapted to the needs of the
individual, and applies the theoretical underpinnings of models to adapt and develop individually tailored and
responsive interventions. Manages complex interactions of belief systems, such as religious, cultural and social
beliefs.
Stage 1
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Stage 2
Stage 3
Stage 4
to move it to the place on the slider you wish to rate.
Comment (indicate via initials a case in which this skill level was demonstrated):
6
Outcome evaluation:
Stage 1:
Uses measures to support diagnoses and track progress in therapy. Uses standard battery of outcome measures
that screen for common disorders, adding to these as required for more specific detail to support diagnosis, refine
treatment and assess more unusual disorders and treatment outcomes.
Stage 2:
Identifies measures for less common disorders and applies these at baseline, during therapy as new disorders
become evident, at handover, and at discharge to assess the trajectory of therapeutic change. Plots sessional
outcomes where a specific intervention allows (e.g. SUDS ratings during exposure, amount of hair pulled for
trichotillomania).
Stage 3:
Appropriately selects the best approach to monitor change and measure outcomes both within and across
treatment sessions.
Stage 4:
Develops unique, meaningful and effective methods for monitoring and evaluating outcomes. Analyses outcome
data for evaluation of personal performance, with the purpose of identifying areas needed for skill development,
new approaches, and interventions for different presentations.
Stage 1
Left click and hold on the arrow
Stage 2
Stage 3
Stage 4
to move it to the place on the slider you wish to rate.
Comment (indicate via initials a case in which this skill level was demonstrated):
7
COMPETENCIES – Interpersonal responsiveness (meta-competency)
Stage 1:
Demonstrates appropriate warmth, compassion, and empathy for suffering in a benign, accepting manner,
regardless of the mode of relating of the individual. Demonstrates the capacity to be actively involved and
responsive (as opposed to passive) to increase collaboration and focus of sessions. Identifies coping styles
(defenses, avoidance strategies, etc.) in interpersonal dynamics and negative affect of the self and other.
Stage 2:
Makes sustained effort to understand the patient and their experiences and history. Demonstrates an involved,
active, and appropriately responsive relating style. Identifies individuals’ coping styles and can describe these
and their purpose, as they occur, to address blocks to therapy. Demonstrates attuned responsiveness to overt
emotion and identifies covert, controlled or denied affect and the impact of this on relationship and response to
therapy. Demonstrates tolerance and thoughtfulness in relation to negative affects of the self and other. Identifies
ruptures in the therapeutic relationship and repairs basic ruptures.
Stage 3:
Applies accurate empathy for and understanding of the current emotional experiences and relating style of the
individual, the circumstances in which these have developed, and their impact on relationships and the
therapeutic alliance. Demonstrates understanding of different personality styles and the resultant needs in the
therapeutic relationship (e.g. providing distance for those with more schizoid styles, and being more active with
those who are difficult to contain). Differentiates empathy for current experience separately from early experience
where these are disconnected for the individual and uses these appropriately. Identifies transference and
countertransference reactions and repairs more difficult relationship ruptures responsively and therapeutically.
Stage 4:
Applies flexible, adaptive and differentiated responsivity throughout assessment, formulation and intervention.
Applies sound judgement and sensitivity in work with strong, negative, controlled, covert or denied affect to
develop insight and awareness. Applies knowledge and understanding of personality styles within the therapeutic
relationship. Repairs therapeutic ruptures, and identifies and addresses transference reactions with acceptance,
understanding, and sensitivity. Works towards healthy relating styles.
Stage 1
Left click and hold on the arrow
Stage 2
Stage 3
Stage 4
to move it to the place on the slider you wish to ra
Comment (indicate via initials a case in which this skill level was demonstrated):
8
COMPETENCIES – Professional
Ethical & Legal:
Stage 1:
Adheres to the profession’s Code of Ethics and to policies and procedures for the service. Conducts clinical work
within an ethical, boundaried, legal framework that ensures adequate informed consent, confidentiality, security of
information, and respect and concern for the rights of the patient/client.
Stage 2:
Identifies common ethical challenges and seeks supervision to resolve these. Addresses ethical challenges to the
therapeutic relationship (e.g. personal questions, attempts at boundary transgressions, erotic transference
reactions) as they arise in a therapeutic manner with the support of supervision, Manages responsibilities to
multiple persons and agencies where conflicts of interest arise.
Stage 3
Manages more challenging ethical issues. Addresses multiple interests as they arise. Identifies and seeks
supervision for complex and conflicting issues.
Stage 4:
Manages reasonably complex ethical issues. Seeks supervision as required. Identifies ethical challenges readily
and requires minimal guidance in addressing common problems.
Stage 1
Left click and hold on the arrow
Stage 2
Stage 3
Stage 4
to move it to the place on the slider you wish to rate.
Comments:
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Administrative:
Stage 1:
Attends to duties in a timely, reliable and responsible manner, for example, note-keeping, file-keeping, report
writing, booking sessions, responding to contact, Intake Duty etc. Writes basic notes and reports that need some
supervisor input and structural editing, but style is quickly learned and incorporated.
Stage 2:
Completes administrative demands such as note-keeping, file-keeping, and report writing punctually and
efficiently. Maintains files to a professional standard, with all relevant material being added to the file immediately
it is received, with minimal if any supervisor input or editing. Maintains clinic space as neat and tidy at all times;
configuration of rooms is returned at the end of the day where furniture is moved; and defects are notified to
appropriate person. .
Stage 3:
Punctually completes reports notes and reports that require little editing or supervision. File keeping requires little
supervision. Reliably organises and follows up required management of patient, such as writing to referring
agents, contacting other health professionals as needed, etc. Takes responsibility for presentation of clinic
facilities, ensuring presentation is professional and clean and defects are rectified.
Stage 4:
Pro-actively resolves administrative issues that may arise and seeks and suggests improvements for the
functioning of the service. Writes sophisticated reports that demonstrate insight and awareness of complexities,
and are written to a professional standard. Maintains presentation of clinic space responsibly.
Stage 1
Left click and hold on the arrow
Stage 2
Stage 3
Stage 4
to move it to the place on the slider you wish to rate.
Comments:
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COMPETENCIES – Personal
Supervision:
Stage 1:
Uses structure, clear direction, direct instruction, and demonstration of the application of basic approaches within
the primary model of training. Manages anxiety related to evaluation adequately. Is open to and incorporates
feedback into practice and is responsive to direction. Works collaboratively with the supervisor.
Stage 2:
Organises time efficiently in supervision. Utilises supervision to extend a solid foundation of skills, reflects on
difficulties with the application and utilisation of the model, and difficulties within the therapeutic relationship.
Plans sessions independently and requests feedback and direction as needed. Uses direct instruction on more
advanced skills and new approaches. Evidences reflective skills yielding insight and improved performance. Is
more focused on the patient, the work and relationship than their own evaluation. Is aware of the supervisor
wanting to help, rather than evaluate.
Stage 3
Works with little direct supervision on technique or content with familiar presentations. Demonstrates a high level
of reflective skills and interest in understanding the complexities of the therapeutic relationship and the intricacies
of advanced therapy. Responds to alternative ways of thinking and approaching new problems and complex
presentations. Shows clear focus on the patient, not the self, and the supervisor as a support.
Stage 4:
Uses supervision as a sounding board for new ideas and approaches and to discuss and extend understanding
of complex cases and issues. Requires and enjoys challenges to previously established ways of thinking and
working. Manages time and personal needs efficiently.
Stage 1
Left click and hold on the arrow
Stage 2
Stage 3
Stage 4
to move it to the place on the slider you wish to rate.
Comment (indicate via initials a case in which this skill level was demonstrated):
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Each of the following personal attributes is essential for practice as a competent clinical psychologist.
Where these are lacking clinical work is generally compromised, as is patient/client care. Please rate
these accordingly (double click on box to fill by clicking on ‘checked’):
Inadequate
Needs
Development
Adequate
Well Developed
Outstanding
Attendance/Punctuality:
Professional dress &
presentation:
Appropriate confidence in role:
Appropriate authority in role:
Professional assertiveness:
Honesty & Integrity:
Knowledge of limitations:
Reliability:
Critical thinking:
Problem solving:
Perceptiveness:
Sound judgement:
Concise & clear communication:
Verbal expression:
Written expression:
Organisation & time
management:
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Inadequate
Needs
Development
Adequate
Well Developed
Outstanding
Preparedness:
Dedication:
Flexibility:
Adaptability:
Openness:
Curiosity:
Responsiveness to patient:
Observing capacity:
Initiative:
Collaboration:
Respect for cultural diversity:
Affect tolerance
Tolerance of ambiguity:
Personal Courage:
Self-reflective:
Accurate self-appraisal:
Awareness of impacts of own
personal attributes:
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Inadequate
Needs
Development
Adequate
Well Developed
Outstanding
Contribution to group
discussion:
Collegiality with colleagues:
Collaborative with other health
professionals:
Respect for support staff:
Self-care:
Care of professional
environment:
Where relevant:
Management of personal stress
& distress
Management of conflict:
Comments:
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PLACEMENT PROGRESS: Whereas in the previous section, trainees were assessed based on a standard of
competence, items in this section must be rated relative to performance of peers and with respect to their current stage of
development. Thus “unsatisfactory”, “slow”, or “excellent” progress may be assigned to trainees at any stage of
development. Please rate the trainee’s progress thus far. If progress is below levels expected, please comment on factors
in the free-text section or under confidential comments below. (e.g., attitudinal barriers, personal issues including illness).
Please double click the appropriate box and select ‘checked’.
EXCELLENT
PROGRESS
The trainee has demonstrated accelerated progress across the placement, much above the rate
expected at this stage of training.
DEVELOPING
WELL
Consistent and good progress has been achieved. The rate of progress matches expectations for
trainees at this stage of training.
INCONSISTENT
PROGRESS
Progress has been inconsistent or patchy across time and/or domains, with satisfactory progress
achieved some of the time/in some domains, but not all the time/across all domains.
SLOW
PROGRESS
Some progress has been made, but progress has been uniformly slow across most domains, or
has been achieved following above-average investments of staff resources. Rate of progress is
below the standard expected at this stage of training.
UNSATISFACTORY
PROGRESS
Progress is considerably slower than the pace expected at this stage of training. Consequently,
little or no change has been observed in the trainee's capabilities. Major deficits in one of more
areas that are of serious concern.
OVERALL EVALUATION:
The material or clinical practice meets the expected level of competence for the stage of
PASS (P)
training. A pass is considered to signify work that is of a good to very good standard,
according to the relevant expectations.
IDENTIFIED
DIFFICULTIES
(ID)
FAIL (F)
The professional and/or clinical practice does not satisfy a basic level of competence. The
student and supervisor must set clear goals for the remainder of the placement that
specify the skills that must be demonstrated prior to the EPR. The trainee may also need
to repeat or complete additional work within a period of time determined by the CPU. The
supervisor is required to re-evaluate any further work.
The student has a sufficiently low level of competence that their continuation would
compromise patient care. The student will be withdrawn from the placement and a fail
recorded.
Verification of Review
By signing this form, you confirm that you have discussed this review with your supervisor. Signing this form does not necessarily indicate that you agree
with this evaluation.
Trainee’s Signature
Date
Supervisor’s Signature
Date
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POSITIVE COMMENTS FROM TRAINEE & SUPERVISOR:
NEGATIVE COMMENTS FROM TRAINEE & SUPERVISOR:
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