Medical Manpower Department,
Our Lady of Lourdes Hospital,
Drogheda,
Co, Louth.
Phone: 041 - 9874682
Fax: 041 - 9874722
REFERENCE FORM FOR NCHD POSITION
URGENT PLEASE RESPOND BY RETURN
TO EMAIL: [email protected]
Applicant’s Name: Dr Murtada Awad Ibraheem Hussien
For the role of: Registrar in Paediatrics
Competition Reference number:
(i)How long have you known the applicant and in what capacity?
From February 2023 To August 2024
Consultant- immediate supervisor
Educational Supervisor
Clinical Director
Other (please specify) …………………………………………
(ii)What was the applicant’s job title: Resident Paediatrician
(iii) Dates of employment: February 2023
Please rate the applicant’s performance in the following areas, by reference to the grade at which
the applicant was employed:
(Please tick)
1) Knowledge/Experience
a. Very able, comprehensive knowledge of speciality
b. Good all round medical knowledge
c. Satisfactory with areas of improvement needed (Key areas of medicine well known but not details
of the specialty)
d. Adequate with some gaps in knowledge
e. Unsatisfactory- Large areas of inexperience
Comments: …………………………………………………………………………………
Medical Manpower Department October 2021 pg. 1
2) Technical Skills
a. Able and highly skilled with relevant/required practical procedures
b. Satisfactory - capable with most practical procedures
c. Satisfactory - Some gaps in performance of procedures
d. Significant area of concern- Poor practically
Comments: ………………………………………………………………………………
3) Attitude to patients and family
a. Usually very thoughtful and caring
b. Generally satisfactory
c. Satisfactory but occasionally failing to think of their needs
d. Unsatisfactory
Comments: …………………………………………………………………………………
4) Relationships with other staff
a. Satisfactory, generally gets on well with most people
b. Satisfactory, an area of strength and professional in dealing with others
c. Adequate and only occasionally conflicts with other colleagues
d. Substantial area of concern - upsets others/does not work as one of a team
Comments: …………………………………………………………………………………
5) Response to stress
a. Unsatisfactory -Exhibits uncertainty in stressful situations/ uncertainty in referral
b. Satisfactory, an area of strength and manages patients well and calmly seeks advice regarding
problems promptly and appropriately having thought them through
c. Adequate, however sometimes uncertain when to discuss potential problems with senior
colleagues
d. Unsatisfactory
Comments: …………………………………………………………………………………
6) Note keeping
a. Unsatisfactory - Inconsistent or poor note keeping
b. Exemplary Always keeps clear, concise problem-orientated notes
c. Satisfactory -Usually keeps well prepared problem-orientated notes
7) Organisational Skills
a. Effective
b. Satisfactory
c. Significant area of concern
Medical Manpower Department October 2021 pg. 2
8) Audit
a. Participates actively in audit
b. Satisfactory Participation
c. Unsure as there were service pressures so cannot assess
d. Will participate but did not demonstrate motivation
e. Unsatisfactory participation
9) Communication Skills
a. Excellent written and verbal communication
b. Satisfactory
c. Satisfactory although there were some gaps in understanding
d. Unsatisfactory- Difficulties in communications (written or) verbal
10) Sickness Absence: Did you have any cause for concern about the applicant’s level of sickness
absences – this? (Can be completed by Medical HR or referee)
Yes No
If yes please specify:
………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………
11) Is the applicant currently subject to any work performance or active disciplinary investigations or
procedures, formal or otherwise during their time with you (including proceedings instigated by the
IMC/ anybody governing medical professionals)? (Can be completed by Medical HR or referee)
Yes No
If yes please describe:
………………………………………………………………………………………………………………………………………………………
12) Would you:
Re-employ the applicant Yes No
recommend him/her to another employer Yes No
recommend him/her to Lady of Lordes Hospital , for this post Yes No
13) General Comments:
Updating general knowledge, cooperative with his colleagues and shows respect towards his seniors.
Medical Manpower Department October 2021 pg. 3
Signed: Dr. Ismail
Print Name: Ismail Elsayed Elmarasi
Title: Specialist of paediatrics
Date: 25/8/2024 Official Stamp:
THANK YOU FOR TAKING THE TIME TO COMPLETE THIS FORM.
PLEASE RETURN TO THE MEDICAL ADMINISTRATION DEPARTMENT AT YOUR EARLIEST
POSSIBLE CONVENIENCE
Medical Manpower Department October 2021 pg. 4
