Post ECHO Session Feedback Survey
The Palliative Performance Scale
Thank you for attending this ECHO session. Your feedback is appreciated and will help us to improve future sessions:
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1.
Please describe your role:
(Required.)
Administrator / Manager
Occupational Therapist
Physiotherapist
Respiratory Therapist
Registered Dietitian
Licensed or Registered Practical Nurse (LPN/RPN)
Nurse Practitioner (NP)
Paramedic
Patient
Caregiver
Pharmacist
Physician – College of Family Physicians of Canada
Physician – Royal College of Physicians and Surgeons
Registered Nurse (RN)
Registered Psychiatric Nurse
Resident
Social Worker
Spiritual Care Provider
Student
Support Worker/ Aide/ Attendant
Other (please specify)
*
2.
Did you watch the session during our live presentation or through the recording?
(Required.)
Live
Recording
*
3.
What gender do you identify with?
(Required.)
Male
Female
Gender diverse
Prefer not to answer
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4.
To what extent do you agree with the following statements?
The session was relevant to my practice
(Required.)
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
*
5.
There was ample opportunity for discussion.
(Required.)
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
*
6.
This session met my learning needs.
(Required.)
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
*
7.
The overall format of the session was useful.
(Required.)
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
*
8.
The presenters were knowledgeable.
(Required.)
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
*
9.
Overall, this ECHO session was a good learning experience.
(Required.)
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
*
10.
I would recommend this session to colleagues.
(Required.)
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
*
11.
The sessions I participated in had participants from professions other than mine. (e.g. physicians, nurses, nurse practitioners, social workers, managers, etc.)
(Required.)
Yes
No
I don't know
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12.
Having participants from different professions in the same sessions added to my learning about topics covered by these sessions.
(Required.)
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
N/A
*
13.
To what extent do you agree with the following statement
Having participants from different professions in the same sessions helps us to improve the care we provide.
(Required.)
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
*
14.
During the session I _________(select all that apply)
(Required.)
Learned new things that I can apply (in my practice or elsewhere)
Confirmed things that I’m doing in my practice
Learned nothing new that is applicable to my practice
15.
If applicable, list up to 2 things you will be doing differently as a result of participating in this session. (please be specific)
16.
If applicable, please describe up to 2 things that you were doing already that were confirmed in this session.
17.
What other topics would you like to learn about through our ECHO programming?
18.
Please share any additional comments.