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* 1. Date of Session:

Date

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* 2. Session Name:

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* 3. Event Facilitator(s)

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* 4. Profession:

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* 5. How many years in practice?

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* 6. Please rate the following:

  Strongly Disagree Disagree Neutral Agree Strongly Agree Not Applicable
1. The overall educational experience of the simulation event was excellent
2. The simulation scenarios were appropriate for the learner group
3. The realism of the simulation event was excellent
4. The post-scenario debriefing was helpful for my learning
5. The learners were treated with respect
6. This simualtion event was well organized
7. The group size of the simulation event was appropriate
8. Interdisciplinary involvement in the simulation event had a positive impact (if applicable)
9. The goals and objectives of this session were met

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* 7. The simulation laboratory/space was comfortable and the simulation equipment functioned appropriately (if not, please comment on specifics)

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* 8. What were the key take home messages of your simulation event?

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* 9. What did you find most useful about your simulation event?

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* 10. How could we improve the education experience of your simulation event?

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* 11. What would you suggest for future scenarios and learning opportunities?

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* 12. Ideally, how often should these simulation events be held?

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* 13. The simulation event was free from perceived bias:

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