Disclosure of Unanticipated Event 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
Promptly identify unanticipated events warranting disclosure to patients and/or their families and implement disclosure of unanticipated outcomes procedure as described in Baptist Health policies.	Promptly identify unanticipated events warranting disclosure to patients and/or their families and implement disclosure of unanticipated outcomes procedure as described in Baptist Health policies. - 5	Promptly identify unanticipated events warranting disclosure to patients and/or their families and implement disclosure of unanticipated outcomes procedure as described in Baptist Health policies. - 4	Promptly identify unanticipated events warranting disclosure to patients and/or their families and implement disclosure of unanticipated outcomes procedure as described in Baptist Health policies. - 3	Promptly identify unanticipated events warranting disclosure to patients and/or their families and implement disclosure of unanticipated outcomes procedure as described in Baptist Health policies. - 2	Promptly identify unanticipated events warranting disclosure to patients and/or their families and implement disclosure of unanticipated outcomes procedure as described in Baptist Health policies. - 1
Explain the outcome of any treatment or procedure to the patient and, when appropriate, the patient’s family or representative, whenever those outcomes differ significantly from the anticipated outcomes or results in serious harm.	Explain the outcome of any treatment or procedure to the patient and, when appropriate, the patient’s family or representative, whenever those outcomes differ significantly from the anticipated outcomes or results in serious harm. - 5	Explain the outcome of any treatment or procedure to the patient and, when appropriate, the patient’s family or representative, whenever those outcomes differ significantly from the anticipated outcomes or results in serious harm. - 4	Explain the outcome of any treatment or procedure to the patient and, when appropriate, the patient’s family or representative, whenever those outcomes differ significantly from the anticipated outcomes or results in serious harm. - 3	Explain the outcome of any treatment or procedure to the patient and, when appropriate, the patient’s family or representative, whenever those outcomes differ significantly from the anticipated outcomes or results in serious harm. - 2	Explain the outcome of any treatment or procedure to the patient and, when appropriate, the patient’s family or representative, whenever those outcomes differ significantly from the anticipated outcomes or results in serious harm. - 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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Disclosure of Unanticipated Event Simulation Evaluation