Intern training - Term assessment form 2022

Closes 31 Mar 2023

Opened 1 Oct 2021


About this form

The purpose of this form is to provide feedback to the intern on their performance and to support the decision about satisfactory completion of internship.

The form is to be completed by the term supervisor and by the intern (for self-assessment) at the mid-point in any term longer than five weeks and at the end of the term.

This form has not been designed for recruitment purposes and should not be used for such purposes.

Instructions for interns

Complete this form before assessment meetings and discuss it with your supervisor at those meetings. Consider your strengths and areas where you could benefit from additional experience.

Your self-assessment is not for submission.

Instructions for supervisors

Complete and discuss the form with the intern. Consider the intern’s self-assessment and the observations of others in the discussion. The supervisor should:

  1. Assign a rating for intern performance against each outcome statement. Note: assigning a rating of 2 or 4 indicates that the performance falls between the descriptions provided.
  2. Use the ‘Not observed’ option where appropriate and note this for further action.
  3. Complete an Improving Performance Action Plan (IPAP) when an intern requires remediation or additional support (e.g. when the intern is assigned ratings of 1 or 2 for one or more items.)
  4. At the end-of-term assessment, assign a global rating of progress towards completion of internship. Review any existing remediation plan to determine if it is complete, or if ongoing actions are required.

Relevant documents

The AMC document Intern training – Assessing and certifying completion will assist in completing this form. The form aligns with the Australian Medical Council and Medical Board of Australia’s Intern training – Intern outcome statements


[i] Intern training – Assessing and certifying completion

[ii] Intern training – Intern outcome statements


  • Metro North HHS Staff - including contractors and students


  • Staff survey