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Other Roles Structured Reflective Template

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					Other Roles Structured Reflective Template
(Leicester Statement – Essential Evidence for Appraisal)
Requirement: complete annually

                                                                                                      Click here to
Name of doctor:            Click here to enter text.                                   GMC No:
                                                                                                      enter text.
Considering my other clinical and non-clinical roles as listed in Form 2 of my appraisal paperwork, in the last
year, these have brought the following benefits to my main clinical role:

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They also brought the following drawbacks to my main clinical role:


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I could consider the following actions, to maximise the benefits and minimise the drawbacks:


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Date reflected:Click here to enter a date.

Final outcome after discussion at appraisal:
(Complete at appraisal considering how your approach will improve patient care)

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posted:9/7/2012
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