PECC ECHO - EMS "SIM in a Box" Program - May 7, 2020

Survey

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* 1. Contact Information

Name

Email Address

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* 2. Occupation

MD

DO

PA

APRN/RN

LPN

EMR

EMT

Paramedic

Other

If Other (please specify)

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* 3. Are you requesting CME or CEU's?

Yes - CME

Yes - CEU

No

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* 4. Hospital/Organization

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* 5. CONTENT

	Strongly Agree	Agree	Disagree	Strongly Disagree
Was organized and easy to follow	Was organized and easy to follow Strongly Agree	Was organized and easy to follow Agree	Was organized and easy to follow Disagree	Was organized and easy to follow Strongly Disagree
Met the objective(s)	Met the objective(s) Strongly Agree	Met the objective(s) Agree	Met the objective(s) Disagree	Met the objective(s) Strongly Disagree

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* 6. TRAINER

	Strongly Agree	Agree	Disagree	Strongly Disagree
Knows and understands the topic	Knows and understands the topic Strongly Agree	Knows and understands the topic Agree	Knows and understands the topic Disagree	Knows and understands the topic Strongly Disagree
Was well organized and prepared	Was well organized and prepared Strongly Agree	Was well organized and prepared Agree	Was well organized and prepared Disagree	Was well organized and prepared Strongly Disagree
Was clear and easy to follow	Was clear and easy to follow Strongly Agree	Was clear and easy to follow Agree	Was clear and easy to follow Disagree	Was clear and easy to follow Strongly Disagree

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* 7. This was a quality CME activity and met the following objectives:

	Strongly Agree	Agree	Disagree	Strongly Disagree
Define simulation and debriefing	Define simulation and debriefing Strongly Agree	Define simulation and debriefing Agree	Define simulation and debriefing Disagree	Define simulation and debriefing Strongly Disagree
Describe the elements of the EMSsimbox intervention	Describe the elements of the EMSsimbox intervention Strongly Agree	Describe the elements of the EMSsimbox intervention Agree	Describe the elements of the EMSsimbox intervention Disagree	Describe the elements of the EMSsimbox intervention Strongly Disagree
Deliver the EMSsimbox to their learners	Deliver the EMSsimbox to their learners Strongly Agree	Deliver the EMSsimbox to their learners Agree	Deliver the EMSsimbox to their learners Disagree	Deliver the EMSsimbox to their learners Strongly Disagree

Comments:

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* 8. Please rate the following statements:

	Strongly Agree	Agree	Disagree	Strongly Disagree
This activity will favorably influence my ability to practice at my EMS level and assist in training others to do so.	This activity will favorably influence my ability to practice at my EMS level and assist in training others to do so. Strongly Agree	This activity will favorably influence my ability to practice at my EMS level and assist in training others to do so. Agree	This activity will favorably influence my ability to practice at my EMS level and assist in training others to do so. Disagree	This activity will favorably influence my ability to practice at my EMS level and assist in training others to do so. Strongly Disagree
I would definitely recommend this activity to my colleagues.	I would definitely recommend this activity to my colleagues. Strongly Agree	I would definitely recommend this activity to my colleagues. Agree	I would definitely recommend this activity to my colleagues. Disagree	I would definitely recommend this activity to my colleagues. Strongly Disagree

Comments:

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* 9. What did you like best about this session?

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* 10. What did you like least about this session?

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* 11. Suggestions for Future Clinic Topics: