Participant Course Survey

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Survey for Simulation Courses Held at UMMC STC Simulation Center

Course Name: *

Course Date *

YYYY

Course Director or Lead Instructor's Name

Hospital you work at or name of your Employer

What type of Clinical Provider are you (select as many as apply to you)

Attending Physician

Fellowship Physician

Resident Physician

Medical School Student

Nurse Practitioner

CRNA

Flight Nurse

LPN

CNA/NA

Nursing Student

Rehab Services

PCT

Flight Paramedic/CCEMTP

Paramedic

EMT

EMR/1st Responder

Other:

Have you done simulation before?

Yes

Clear selection

IF you have done Simulation before approximately how many times have you done it?

2-4

5-10

10+

Clear selection

Please rate: Functionality of of simulator:

5 Satisfied

4 Somewhat Satisfied

3 Neutral

2 Somewhat Dissastified

1 Dissatisfied

NA/Not Applicable

Clear selection

Please rate: Realism of the simulation

5 Satisfied

4 Somewhat Satisfied

3 Neutral

2 Somewhat Dissastified

1 Dissatisfied

NA/Not Applicable

Clear selection

Please rate: Your engagement with the simulation

5 Satisfied

4 Somewhat Satisfied

3 Neutral

2 Somewhat Dissastified

1 Dissatisfied

NA/Not Applicable

Clear selection

Please rate: The clarity of the instructor/your ability to understand the instructor

5 Satisfied

4 Somewhat Satisfied

3 Neutral

2 Somewhat Dissastified

1 Dissatisfied

NA/Not Applicable

Clear selection

Please rate: The instructor's ability to answer questions

5 Satisfied

4 Somewhat Satisfied

3 Neutral

2 Somewhat Dissastified

1 Dissatisfied

NA/Not Applicable

Clear selection

Please rate: The quality/applicability of the debriefing session

5 Satisfied

4 Somewhat Satisfied

3 Neutral

2 Somewhat Dissastified

1 Dissatisfied

NA/Not Applicable

Clear selection

Please rate: The content of the course

5 Satisfied

4 Somewhat Satisfied

3 Neutral

2 Somewhat Dissastified

1 Dissatisfied

NA/Not Applicable

Clear selection

Please rate: The time flow/organization of the course

5 Satisfied

4 Somewhat Satisfied

3 Neutral

2 Somewhat Dissastified

1 Dissatisfied

NA/Not Applicable

Clear selection

Please rate: The length of the course

5 Satisfied

4 Somewhat Satisfied

3 Neutral

2 Somewhat Dissastified

1 Dissatisfied

NA/Not Applicable

Clear selection

Please rate: How well the course met it's objectives

5 Satisfied

4 Somewhat Satisfied

3 Neutral

2 Somewhat Dissastified

1 Dissatisfied

NA/Not Applicable

Clear selection

Please rate: How this course compared to other courses that did not use simulation

5 Satisfied

4 Somewhat Satisfied

3 Neutral

2 Somewhat Dissastified

1 Dissatisfied

NA/Not Applicable

Clear selection

Please add any additional comments or feedback that you have in this section:

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