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Updated October 2023, effective from January 2024
Download Counselling EPA - Patient Carer Feedback Form (2 pages DOCX)
For completion by: Patient/carer or by the supervisor in conversation with the patient/carer. It should not be completed by the intern.
Purpose: To collect feedback from patients or carers following counselling by an intern.
This form is to be used to collect feedback from patients or carers following counselling by an intern. It may be completed by the patient/carer or by the supervisor in conversation with the patient/carer. In general, it should not be completed by the intern.
As key stakeholders, and integral participants in the counselling process, feedback on their experience should be sought from patients and carers and used to assist the intern in developing skills and confidence. The patient/carer should be asked in advance for consent to provide feedback.
Seeking feedback from the patient or carer may be more appropriately be carried out by a third party such as the supervisor. The template is very simple and can be augmented by additional questions or comments if the discussion proceeds in particular directions. Where the feedback is collected though a discussion between the patient/carer and supervisor (or other staff member), the questions which are asked do not need to correspond to the questions on the form, but can be chosen according to the particular situation. What is important it to capture the patient/carer experience as clearly as possible.
Refer to the Counselling - Preceptor and intern user guide for further information on how to use this tool.