Have you observed any behaviours that cause you to have concerns about
the following:
Collegiality (e.g. conflict with staff, issue with other learner)
No.
Clinical judgement (e.g. over confident, dangerous decision, overly
hesitant)
No.
Patient-centred care (e.g. disrespect, conflict, boundaries)
No.
Reliability or responsibility (e.g. excessive absences, incomplete records,
missed calls)
No.
Receiving feedback or maintaining professionalism (e.g. disruptive
behaviours that impede feedback or disrupt clinic flow).
No.
Other observed behaviour(s) or trait(s), not otherwise described, that may
impact this applicant’s suitability for a position in a Family Medicine
residency.
No.
Supporting Narrative
Briefly, please tell us about a specific situation such as an observed patient encounter or other
observed experience that exemplifies what makes this applicant an ideal candidate for family
medicine.
This is where the narrative would be displayed.
Summative Statements:
Did this applicant demonstrate an interest in Family Medicine? (Choose one best answer):
Definitely yes! For example, the applicant specifically described how to apply this experience to their
future in Family Medicine.
Do you believe this applicant demonstrates the skills and personality traits supportive of
suitability for a rural family medicine residency? These would include being self-directed,
having a spirit of adventure, and demonstrating a tolerance for working in professionally or
socially isolated environments.
Definitely yes!
Would you be happy to be this applicant’s preceptor for the two years of Family Medicine
Residency?
Definitely yes!
Final Statement (choose one):
I would strongly recommend this applicant for a Family Medicine residency position.
Date: September 16, 2021
Signature: This letter was submitted using CaRMS Online.