Multi-source Feedback (Anaesthesia Practice)

A voluntary, quality improvement activity

Thanks for agreeing to be a part of this process. The anaesthetist who has given you this form is participating in this voluntary activity as part of the Australian and New Zealand College of Anaesthetists (ANZCA) and Faculty of Pain Medicine (FPM) Continuing Professional Development (CPD) Program.

The purpose of the multi-source feedback is to guide improvement of anaesthetists by asking colleagues and co- workers to identify attributes that can be developed further and/or addressed if necessary.

Feedback responses have been requested from others, including: anaesthetists, surgeons, anaesthetic nurses/technicians and anaesthetic trainees (if applicable). Other members of the team you work with also may have been approached, for example: pain nurses, post-anaesthesia care unit staff, scrub scout personnel and administrative staff.

Please provide honest feedback

Please provide honest feedback on the form, by indicating whether you observe the participant never, sometimes, usually or consistently demonstrating the attributes listed on the left-hand side of the form. You are encouraged to indicate if you have not observed any particular item, if this is the case please mark the “not observed” box.

Your feedback is confidential and will be emailed to a facilitator who will collate the results from individual forms on to a summary sheet and provide de-identified feedback to the anaesthetist based on this summary. The anaesthetist does not view individual forms. The facilitator will destroy them after responses are included in a summary document.

Anaesthetists

Dr Craig Coghlan

Dr Mick (Michael) Reid

Dr Liz Vallins

Dr Margot Heaney