Advanced Pediatric Simulation Evaluation

Please score your agreement with or assessment of the following questions and statements by rating on a scale of 1 to 5, with 5 representing the highest level of satisfaction or agreement. *

Scoring Key: 5=Strongly Agree 4=Agree 3=Neutral 2=Disagree 1=Strongly Disagree

	5	4	3	2	1
The information and/or skills learned will enhance my professional competence or ability.	The information and/or skills learned will enhance my professional competence or ability. - 5	The information and/or skills learned will enhance my professional competence or ability. - 4	The information and/or skills learned will enhance my professional competence or ability. - 3	The information and/or skills learned will enhance my professional competence or ability. - 2	The information and/or skills learned will enhance my professional competence or ability. - 1
This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients.	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 5	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 4	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 3	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 2	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 1

As a result of participating in this course, to what extent do you agree that you will be better able to accomplish these objectives *

Scoring Key: 5=Strongly Agree 4=Agree 3=Neutral 2=Disagree 1=Strongly Disagree

	5	4	3	2	1
Explain the basic principles of effective teamwork- leadership, role clarity and closed loop communication.	Explain the basic principles of effective teamwork- leadership, role clarity and closed loop communication. - 5	Explain the basic principles of effective teamwork- leadership, role clarity and closed loop communication. - 4	Explain the basic principles of effective teamwork- leadership, role clarity and closed loop communication. - 3	Explain the basic principles of effective teamwork- leadership, role clarity and closed loop communication. - 2	Explain the basic principles of effective teamwork- leadership, role clarity and closed loop communication. - 1
Utilize effective communication skills within a multidisciplinary team.	Utilize effective communication skills within a multidisciplinary team. - 5	Utilize effective communication skills within a multidisciplinary team. - 4	Utilize effective communication skills within a multidisciplinary team. - 3	Utilize effective communication skills within a multidisciplinary team. - 2	Utilize effective communication skills within a multidisciplinary team. - 1
Recognize the importance of Crisis Resource Management principles in patient safety.	Recognize the importance of Crisis Resource Management principles in patient safety. - 5	Recognize the importance of Crisis Resource Management principles in patient safety. - 4	Recognize the importance of Crisis Resource Management principles in patient safety. - 3	Recognize the importance of Crisis Resource Management principles in patient safety. - 2	Recognize the importance of Crisis Resource Management principles in patient safety. - 1
Apply advanced teamwork and communication skills in daily practice.	Apply advanced teamwork and communication skills in daily practice. - 5	Apply advanced teamwork and communication skills in daily practice. - 4	Apply advanced teamwork and communication skills in daily practice. - 3	Apply advanced teamwork and communication skills in daily practice. - 2	Apply advanced teamwork and communication skills in daily practice. - 1

Regarding the scenario in which you participated, to what extend would you agree that: *

Scoring Key: 5=Strongly Agree 4=Agree 3=Neutral 2=Disagree 1=Strongly Disagree

	5	4	3	2	1
The content of the scenario was current and relevant to my practice.	The content of the scenario was current and relevant to my practice. - 5	The content of the scenario was current and relevant to my practice. - 4	The content of the scenario was current and relevant to my practice. - 3	The content of the scenario was current and relevant to my practice. - 2	The content of the scenario was current and relevant to my practice. - 1
The scenario was realistic.	The scenario was realistic. - 5	The scenario was realistic. - 4	The scenario was realistic. - 3	The scenario was realistic. - 2	The scenario was realistic. - 1

Regarding the debriefing, to what extent would you agree that: *

Scoring Key: 5=Strongly Agree 4=Agree 3=Neutral 2=Disagree 1=Strongly Disagree

	5	4	3	2	1
The debriefing encouraged open dialogue.	The debriefing encouraged open dialogue. - 5	The debriefing encouraged open dialogue. - 4	The debriefing encouraged open dialogue. - 3	The debriefing encouraged open dialogue. - 2	The debriefing encouraged open dialogue. - 1
I felt at ease throughout the debriefing discussion.	I felt at ease throughout the debriefing discussion. - 5	I felt at ease throughout the debriefing discussion. - 4	I felt at ease throughout the debriefing discussion. - 3	I felt at ease throughout the debriefing discussion. - 2	I felt at ease throughout the debriefing discussion. - 1
The debriefing helped me discover areas of improvement.	The debriefing helped me discover areas of improvement. - 5	The debriefing helped me discover areas of improvement. - 4	The debriefing helped me discover areas of improvement. - 3	The debriefing helped me discover areas of improvement. - 2	The debriefing helped me discover areas of improvement. - 1

Was this course fair, balanced and without commercial bias? *

Yes

No

If you checked "No,” please explain why: *

Would you recommend this course to your colleagues *

What did you take away from the debriefing process? In what ways did you benefit from the discussion? *

Give an example of how the debriefing discussion changed your perspective on how to apply crisis resource management in your clinical practice. *

Name

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Advanced Pediatric Simulation Evaluation