GENERAL

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* 1. Please enter the date of your simulation.

Date

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* 2. What group/department was the simulation performed for?

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* 3. What is your current position?

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* 4. Who were your CLINICAL educators present at the simulation?

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* 5. Who was the SIMULATION educator present at the simulation?

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* 6. I found the simulation useful and a good use of my time.

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* 7. The simulation topic was appropriate to my discipline.

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* 8. Regarding the difficulty of the simulation, I found it to be:

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* 9. From this simulation experience I acquired new knowledge and/or skills.

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* 10. Prior to the simulation, I knew what to expect and what was expected of me.

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* 11. If answering 'Disagree' or 'Strongly Disagree' to Question 10, what would help better prepare you for the simulation sessions?

LEARNING ENVIRONMENT

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* 12. I felt the learning environment was safe.

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* 13. The environment the simulation was performed in contributed to the overall realism.

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* 14. Any comments about the learning environment?

SIMULATION

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* 15. I felt comfortable and engaged during the SIMULATION.

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* 16. The mannequin was realistic (e.g. sounds, pulses, breathing, procedural accuracy).

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* 17. The vitals signs on the monitor accurately reflected the patient's status and were appropriately adjusted based on interventions.

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* 18. If utilized, the labs and imaging contributed to the realism of the simulation.

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* 19. Any comments about the actual simulation?

DEBRIEFING

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* 20. Name the person(s) who primarily facilitated the debriefing; this may be a simulation educator, clinical educator or both.

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* 21. The debriefers were knowledgeable about the simulation subject matter.

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* 22. The debriefers were well-prepared for the simulation.

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* 23. During the debriefing, the facilitators outlined what we DID WELL.

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* 24. The debriefers identified above discussed what we could IMPROVE UPON.

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* 25. Feedback received during the debriefing was constructive without coming across as paternalistic or condescending. 

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* 26. I felt comfortable and engaged during the DEBRIEFING. 

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* 27. Any comments about the debriefing process or those leading the debriefing?

TIME

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* 28. The simulation started at the scheduled time.

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* 29. The time spent on the SIMULATION was appropriate.

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* 30. The time spent on DEBRIEFING was appropriate.

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* 31. Any comments regarding time?

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* 32. Do you have ANY other comments regarding your simulation experience?

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