ATTITUDE EVALUATION FORM

for Stage 3.1 & Stage 3.2

A. For the Student

This form aims to evaluate attitude in Stage 3.1 and Stage 3.2 students, which constitutes a part of the Attitude
Evaluation assessment under the Personal and Professional Development theme.
In addition to the aspects assessed in this form, the student will be also assessed on e-log book (e.g. deadline,
completeness), originality, honesty, unbiased conduct towards patients and any other assessments deemed
appropriate by the Department/Faculty.
Failure to satisfactorily complete the Attitude Evaluation assessment may cause the student to fail the Personal and
Professional Development theme and/or will be taken disciplinary actions.

I, ________________________________ (Name of the Student), __________________ (Matric Number) have

read and understood the consequences of failing in the Attitude Evaluation assessment.

Department: Posting:

Date of Posting: until Stream:

Signature of the Student:

B. For the Posting Supervisor

Please tick the appropriate box.
No Not observed Unacceptable Below Met
Attitude and/or Behavior Not applicable Expectations Expectations
1 The student was present on time for all teaching sessions, except
with valid reason for absence.
2 The student accepted feedback and adopted corrective
measures.
3 The student demonstrated respect for patients and their families.
4 The student worked co-operatively and communicated effectively
with colleagues.
5 The student communicated effectively with healthcare staff
(including the Supervisor).
Note: The passing grade is “Met Expectations” for every attitude/behavior.

6a. Please assess this student’s overall attitude performance during this posting
( ) Unacceptable ( ) Below Expectations ( ) Met Expectations

6b. If the student is deemed to be “Unacceptable” or “Below Expectations”, please provide your observations:
______________________________________________________________________________
______________________________________________________________________________

Name of the Supervisor: Date:

Signature:

Note: The Supervisor should complete and return the form to their respective Department by 7th week of the
posting. It will facilitate the processing of the overall assessment results.

C. For the Department

Date Received:

The Department should send the collected forms to MERDU by the end of the posting. Copies of the form must be
kept for record purposes in the Department.

Version 29 August 2017