North Western Deanery
Appraisal for Primary Care Dental Practitioners who are
Education Supervisors
Pre-Appraisal Forms Part B
May 2012
Please keep the ORIGINALS of these forms in your
folder and send COPIES to your Appraiser.
The Pre-Appraisal Part A should be read alongside
these forms to assist you in reflecting on your
practise.
Appraisee ________________________________
Appraised By______________________________
Date signed off_____________________________
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North Western Deanery
Appraisal for Primary Care Dental practitioners who are Educational
Supervisors
FORM 1: BASIC DETAILS
Name
Registered address and telephone number
Main practice address and telephone number (if applicable)
Any other practices that you perform your work
Professional Qualifications UK or elsewhere, with dates
GDC Registration Type now held, registration number and date of first full registration
Date of appointment to current post of Education Supervisor
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North Western Deanery
Appraisal for Primary Care Dental practitioners who are
Educational Supervisors
FORM 2: CURRENT DENTAL ACTIVITIES
This form requires a brief and factual description of the work you do as an
Educational Supervisor in general practice and in other posts. You will be able
to give more detail later.
Name
Practice
Please summarise the ‘in-hours’ activities you undertake in general
practice with your DF1 e.g. minor surgery, sedation, orthodontics
Brief details of other clinical work which takes you away from the
Practice eg as clinical assistant, hospital practitioner etc
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Making a start as you reflect on your practise as an Educational
Supervisor:
Has the past year been good/bad/satisfactory or otherwise for you, and why?
What do you consider to be your most important achievements as Educational
Supervisor in the past year?
What do you like and dislike about your role as Educational Supervisor?
What elements of this role do you find the most difficult?
What elements of your role interest you the most, and least?
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Form 3
Name
Practice
Section 1: Good clinical care
What do you think are your clinical strengths that you use as an Educational
Supervisor?
What steps have you taken to accommodate the DF1 in the practice?
What are the main strengths in your clinical observation, assessment and record
keeping for your DF1?
What evaluation tools have you utilised to quality assure your role as an
educator?
What steps have you taken since your last appraisal to ensure that the DF1 is
exposed to a full range of Clinical Treatments?
What do you think are your development needs for the future? What aspirations
do you have?
This is in preparation for agreeing an updated PDP.
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What factors in your workplace(s) or more widely, constrain you significantly
in achieving what you aim for in your clinical work?
It may be constructive to focus on issues that can be addressed locally, or ways wider issues could be
addressed locally.
How do you manage any treatment not provided in your practice setting?
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Documents in Support
Evidence
Seen
Evidence Provided
Evidence
Seen
Evidence Provided
Working within competence – referral patterns
Audit Data (including significant events audit)
DEP forms in different treatment
competencies
Audit data which includes the DF1
Feedback from Colleagues/ peer review
Critical Incident Reports or near misses which
involve the DF1
Vital Signs
Management of treatment not provided within
practice
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North Western Deanery
Section 2: Communication
Commentary – How have you applied educational theory to inform practice?
How have you used the following to illustrate good practice;
Record cards?
Information leaflets?
Consent?
What discussions have you had with the DF1 about confidentiality, diversity
and equality?(eg language difficulties?)
What factors in your role as educational supervisor constrain you in
completing;
Your weekly tutorials?
Recording the outcomes of your tutorials?
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What tools do you use to assess the learner?
How do you give constructive feedback to your DF1?
How do you guide learners on personal and professional development?
What would you like to do better? What do you think your current needs are in
this area?
This is in preparation for agreeing a PDP
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North Western Deanery
Documents in Support
Communication
well to patients?
How can I show that the DF1 how to relate
Evidence
Seen
Evidence Provided
Clinical record cards – clear and legible
Clinical record cards – Informative and
explanatory
Referral letters - clear and legible
Referral letters - Informative, explanatory and
relevant
Anonymised Clinical records audit
Complaints handling policy – any examples of
its implementation
Lab work – information on lab tickets
Quarterly progressive development records
completed in electronic portfolio
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Section 3: Management and leadership
How do you plan your absences to allow safe practice for the remaining
team?
Have you adequate educational skills to provide good quality training for the
learner? What would you like to do better?
This is in preparation for agreeing a PDP
What factors in your workplace or more widely significantly constrain you in
achieving what you aimed for in this area?
What can be addressed locally?
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North Western Deanery
Documents in Support
Management and Leadership; Narrowing the margin for error as team leader
Evidence
Evidence Provided
Seen
Staff meetings – how often, documentation,
action plan, follow-up
Complaints process / feedback (evidence of
any received)
Significant/adverse event reports
Patient feedback (include thank you
letters/cards)
Record of quarterly progressive development
in electronic portfolio
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Section 4: Professionalism
How do you ensure the appropriate level of supervision for your DF1?
How do you recognise the importance of your role as educational supervisor
in the development of the DF!?
How have you developed your relationship with the DF1? Has it reached the
level you hoped to achieve?
What professional or personal factors significantly constrain or compromise
you in this area?
What would you like to do better? What do you think are your current
development needs in this area?
This is in preparation for agreeing a PDP
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Documents in Support
Professionalism
What does it mean to be a Dental Professional?
Evidence
Evidence Provided
Seen
Professional Indemnity
Peer review; opportunities to discuss
professional work with colleagues
Multi-source feedback eg. 360 feedback, thank
you cards, patient surveys, staff surveys
Adequate supervision through portfolio and
attendance records
Any other additional information
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