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Northwest Geriatrics Workforce Enhancement Center

Practicum: Profile + Pre-Survey

Northwest Geriatrics Workforce Enhancement Center

We’d appreciate it if you could share a bit about yourself. This information is reported to our funding agency (aggregated and anonymous) and plays a vital role in helping us continue to offer free educational programs. If you have any questions, feel free to contact us at nwgwec@uw.edu. Thank you!
1.What is your name (First and Last)?(Required.)
2.At what email address would you like to be contacted? (We will ask you to fill out a Post-Survey and send a reminder to fill it out)
3.What's your current health profession?(Required.)
4.What version of our practicum are you completing?(Required.)
5.Please note which -if any- Area Agency on Aging you working with for the Practicum.(Required.)
6.Which -if any- training program are you affiliated with?(Required.)
7.What setting do you currently work -or train- in (mark all that apply)?(Required.)
8.How many patients over 65 years of age have you cared for in a typical month?(Required.)
9.How confident are you with the following?
1 - Not at all Confident
2
3
4
5 - Confident
6
7
8
9
10 - Totally Confident
Describing the roles of an AAA
How to locate an AAA for any patient in the US
Describing the role of an AAA case manager in the care of older adults
Identifying community resources that support unpaid caregivers (e.g. family members)
Describing community resources that help maintain an older adult’s independence 
Referring older adults to AAA resources
Describing community resources available to support those with dementia and their caregivers
10.I rate my ___________________ for Age-Friendly Care (4Ms: what Matters Most, Medications, Mentation, Mobility)
1 (Low)
2
3
4
5 (High)
Knowledge
Confidence
11.How often are you currently referring community-based resources to older patients?
Never
Rarely
Sometimes
Often
Always
Not Applicable (I'm not seeing patients or other reason)