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* 1. Date of course

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* 2. What is your profession?

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* 3. Please rate the faculty for this course:

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* 4. Please rate the overall quality of this educational activity

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* 5. What was done well with this activity?

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* 6. What suggestions do you have to improve the activity?

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* 7. As a result of participating in this activity (check all that apply)

  Strongly agree Agree Neutral Disagree Strongly disagree
My communication skills with other members of the team have improved
I have acquired new strategies and skills to improve patient outcomes
There is mutual respect between members of the team
I better understand my role and that of the other members of the team
The performance of the team has improved
I can accurately identify sepsis, electrolyte disorders, and respiratory failure
I can state the indications for referrals for further evaluation and treatment of shock
I can list signs and symptoms of systemic allergic reactions and describe/demonstrate the appropriate emergency treatment
I can identify discuss sepsis guidelines

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* 8. As a result of participating in this activity, I am better able to integrate a team based approach to caring for our patients.

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* 9. An example of what our team will change is:

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* 10. Your information

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