ࡱ>   bjbj ^384\TD~..///t2t2t2eDgDgDgDgDgDgD$dFIfDt22^t2t2t2D//D(@(@(@t2F//eD(@t2eD(@(@BiC/u32RACQDD0DUC|I 6|I(iC|IiCt2t2(@t2t2t2t2t2DD>6t2t2t2Dt2t2t2t2|It2t2t2t2t2t2t2t2t2 :  FACULTY OF HEALTH AND WELLBEING BSc (Hons) Radiotherapy & Oncology & MSc Radiotherapy & Oncology in Practice PLACEMENT REPORT RECORD Year: ________ Department: __________________________ Student's name: ___________________ ROLE OF THE MENTOR Mentors play a key role in the appraisal of the students' development of clinical expertise A mentor will be allocated for EACH student on a unit and the role will last for the duration of the placement on that unit only. Allocation of the mentor will take into account annual leave, commitments of individual radiographers and student preference. Any qualified radiographer may act as a mentor provided that: They have attended the mentor training workshop. They are fully familiar with the department (if they are a new member of staff). If individual radiographers do not wish to act as a mentor they should make this known to other team members. Wherever possible, the student should not ask their mentor to act as their clinical assessor during that particular placement. Mentor's role and placement report book guidelines The mentor will act as a facilitator for student learning during the placement but NOT TO THE EXCLUSION OF OTHER RADIOGRAPHERS. Students should note that all team members are available to discuss clinical issues and sign case reports. The mentor (or member of academic staff) and student will negotiate individual learning outcomes and complete the first part of the placement report form during the FIRST TWO DAYS of the placement. Mentors should take into account yearly learning outcomes and the student's individual requirements based on previous comments in the placement report book. During this initial discussion the mentor will arrange and facilitate the mechanisms by which the learning outcomes may be achieved and then communicate this to other team members. A date for the mid placement discussion should be arranged at this time also. Achievement of some learning outcomes may necessitate 1:1 discussion with the student, the timing of which must be negotiated with other team members. The mentor or any other appropriate member of staff may undertake this. At all times students should be encouraged to take ownership of their clinical education. It is not the mentor's responsibility to ensure that learning outcomes are achieved - their role is to FACILITATE their achievement. An interim discussion MUST be held mid way through the placement (if longer than 2 weeks) so that progression and development of the student can be monitored and that appropriate corrective measures (if needed) can be implemented. If problem areas/weaknesses are identified, either by the student or the mentor, then strategies to overcome these should be instigated by the mentor (in collaboration with academic staff if appropriate). Any outcomes of this discussion should be recorded on the placement report form. Towards the end of the placement the student must complete the section entitled 'Student Reflection' providing a considered and reflective evaluation of their placement. Mentors should NOT complete the report form unless this section is completed. During the last 2 days of the placement (and definitely within 2 days of the placement ending) the mentor, in conjunction with other team members (by an informal or formal procedure), will complete the placement report form adding detailed written comments as required. The placement report book should be returned to the student at the end of the placement (and definitely within 2 days of the placement ending). At this time the mentor and student should undertake an end of placement discussion to clarify the feedback and allow opportunity for student comment. Placement report books MUST NOT be retained by clinical staff on the units. In completing the placement report form and holding an end of placement discussion the mentor should make some recommendations with regard learning outcomes for subsequent placements and feed forward via action planning. The mentor should act as the primary source of feedback to the academic course team regarding any issues with individual students or of general clinical education issues. The placement report book will form the basis for the performance review which will be undertaken for each student ONCE per semester. The review will involve the individual student, a senior radiographer and the lecturer with clinical responsibilities for that department. The placement report book forms an integral part of the Clinical Portfolio. It is the student's responsibility to ensure that they do not lose the book and that it is maintained in a neat and professional manner.  It is the students responsibility to ensure that they have read any relevant documentation when they arrive on the placement and seek staff confirmation. A staff signature confirms that the student has been directed to the relevant information and that they have been given the time and opportunity to read the content. Staff are NOT expected to confirm the students understanding of this information. Relevant documents must be read in line with departmental policy i.e. to be read on every new placement or to be read annually. Please feel free to add in any additional relevant information that you have directed the student to read. Students SignatureStaff SignatureDate completed Local Rules COSHH Information Fire Procedure Accident reporting  Uniform Policy   Radiation Protection         All training resources, guidance on mentorship and assessment as well as electronic copies of this Placement Report Book can be located on the SHU Placement Website. Please familiarise yourself with the information provided around SHU policies and procedures, including quality assurance and placement monitoring.  HYPERLINK "https://www3.shu.ac.uk/HWB/placements/RadiotherapyAndOncology/" https://www3.shu.ac.uk/HWB/placements/RadiotherapyAndOncology/  PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date ............................. PLACEMENT REPORT FORM Student Name: Placement: Name of Mentor: Length of Placement (days): Date of Interim Discussion:  Learning Outcomes for this Placement 1. 2. 3. 4.  INTERIM DISCUSSION Date: Learning Outcomes  Not Met Progressing Well Has met the Learning Outcome1. 2. 3. 4.   Mentors: Please add some comments for the students to help them develop an action plan for the remainder of the placement. The comments should reflect areas of their practice they need to develop in line with learning outcomes set for this placement. Please assist the student in writing additional learning outcomes if by the interim, more than 1 learning outcome has been achieved. Mentor Comments and Student Action Plan for the Remainder of the Placement  END OF PLACEMENT REPORT DISCUSSION REFLECTION: (to be completed by the student at end of placement) Student: You should now reflect upon your placement and identify what learning outcomes you feel have been achieved. Based on your mentor feedback a SMART action plan should be produced to feed forward to your next placement. Achievement of Learning Outcomes   You MUST complete the University Placement Evaluation forms. These are sent to you via email at the end of each placement block. Action Plan for Future Placements  MENTOR FEEDBACK Mentors: Please tick where appropriate and if development is required you may wish to add in some additional comments to assist students to action plan accordingly. Progression Skills Development RequiredMeeting Expectations (appropriate for current stage of training)CommentsCompassion, dignity & respect shown to patients & carersAppearance & punctuality Professional attitudeCommunication with staff Communication with patients & carers Application & commitment to work Clinical competence Team working/ MDT working Initiative & recognition of personal limitations  SECTION FOR COMPLETION BY MENTOR AND STAFF ON PLACEMENT: Attendance Length of placement (days): Number of days absent:  Additional Mentor Comments  Signature of Mentor and Team .......................................................................... This placement report has been seen and discussed with me: Signature of Student ................................................... Date ............................. Signature of PLT ............................................... Date .............................      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$Ifgd3pkd$$Ifl\  t0644 lap(yt?kd$$Ifl\  t0644 lap(yt $Ifgd3p?kdn$$Ifl\  t0644 lap(yt $Ifgd3p?kd($$Ifl\  t0644 lap(yt $Ifgd3pžÞĞ $Ifgd3pĞŞƞǞȞɞʞ˞H?????? $Ifgd3pkd$$Ifl\  t0644 lap(yt˞̞͞ΞϞO?72gd3p$a$gd3pkd$$Ifl\  t0644 lap(yt $Ifgd3pOPxooooooooo $Ifgd3pukdV$$Ifl    U""    0    "44 lap yt3p $$Ifa$gd3pgd3p РѠ$a$gd3pgd3pfkd$$Ifl    U""0    "44 layt3p $Ifgd3p !"#$}ttttttttttt $Ifgd3pukd$$Ifl    U""    0    44 lap yt3p $$Ifa$gd3p $%&'()*+,-Ңw $$Ifa$gd3p$a$gd3pgd3pfkd- $$Ifl    U""0    44 layt3p $Ifgd3p ҢӢԢբ֢עآ٢ڢۢܢݢޢߢ $Ifgd3pukd $$Ifl    U""    0    44 lap yt3p$a$gd3pgd3pfkdX $$Ifl    U""0    44 layt3p $Ifgd3pң $$Ifa$gd $Ifgd3pWXYZ:1111 $Ifgd3pkd $$Ifl~\% t0Q'644 l / a5p(ytZ[uvwxyF===== $Ifgd3pkd $$Ifl~\% t0Q'644 la5p(ytyz{=kdk $$Ifl~\% t0Q'644 la5p(yt $Ifgd3pyz{ޤߤ!"#BCDyz|JMɧ̧;_~  #$Ǵ쪣hh3p5CJ\^Jhh3pCJhh3p5CJ\ h3p5>*hh3p5>*hh3p5>*CJ h5yuh3ph3phhh3p5hh3p5\hh3pCJ^J hh3phh3pCJOJQJ2F===== $Ifgd3pkd" $$Ifl~\% t0Q'644 la5p(ytڤۤܤ=kd $$Ifl~\% t0Q'644 la5p(yt $Ifgd3pܤݤޤߤ=kd$$Ifl~\% t0Q'644 la5p(yt $Ifgd3p=kdG$$Ifl~\% t0Q'644 la5p(yt $Ifgd3p !" $Ifgd3p"#=>?@AF===== $Ifgd3pkd$$Ifl~\% t0Q'644 la5p(ytABCDuvw=kd$$Ifl~\% t0Q'644 la5p(yt $Ifgd3pwxyz{=88gd3pkdl$$Ifl~\% t0Q'644 la5p(yt $Ifgd3påĥťfkd#$$Ifl     P!0    P!44 layt3p $Ifgd3pgd3p*fkd$$Ifl     P!0    P!44 layt3p $Ifgd3pfkd$$Ifl     P!0    P!44 layt3p !"#${rrrrrrrr $Ifgd3pskdv$$Ifl     Q!    0    Q!44 lap yt3p $$Ifa$gd3pgd3p $%&'()*ϦЦ<=gd3pekd$$Ifl    1 Q!0    Q!44 layt3p $Ifgd3pʧ˧̧ڧۧܧ $Ifgd3p$a$gd3pgd3pܧݧ $Ifgd3pfkd$$Ifl    U""0    "44 layt3p567}}}}} $Ifgd3pykd $$Ifl    0<U"0    "44 layt3p789:;`u $$Ifa$gd3pgd3pykd$$Ifl    0<U"0    "44 layt3p`abcfghilmnorst $Ifgd3pukd $$Ifl    U""    0    44 lap yt3ptuxyz{|}~gd3phkd$$Ifl     U"" 0    44 layt3p $Ifgd3pҨӨԨըݨި $$Ifa$gd $Ifgd3pgd3p H?????? 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