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Practicum Post-Survey
Area Agency on Aging (AAA) Practicum
*
1.
What's your
name
(first and last)?
(Required.)
*
2.
Please rate how well your practicum modules met your expectations.
(Required.)
Excellent
Good
Average
Fair
Poor
Excellent
Good
Average
Fair
Poor
*
3.
How
confident
are you with the following?
(Required.)
1 - Not at all
Confident
2
3
4
5 -
Confident
6
7
8
9
10 - Totally
Confident
Describing the roles of an AAA
1 - Not at all
Confident
2
3
4
5 -
Confident
6
7
8
9
10 - Totally
Confident
How to locate an AAA for any patient in the US
1 - Not at all
Confident
2
3
4
5 -
Confident
6
7
8
9
10 - Totally
Confident
Describing the role of an AAA case manager in the care of older adults
1 - Not at all
Confident
2
3
4
5 -
Confident
6
7
8
9
10 - Totally
Confident
Identifying community resources that support unpaid caregivers (e.g. family members)
1 - Not at all
Confident
2
3
4
5 -
Confident
6
7
8
9
10 - Totally
Confident
Describing community resources that help maintain an older adult’s independence
1 - Not at all
Confident
2
3
4
5 -
Confident
6
7
8
9
10 - Totally
Confident
Referring older adults to AAA resources
1 - Not at all
Confident
2
3
4
5 -
Confident
6
7
8
9
10 - Totally
Confident
Describing community resources available to support those with dementia and their caregivers
1 - Not at all
Confident
2
3
4
5 -
Confident
6
7
8
9
10 - Totally
Confident
*
4.
I rate my ___________________ for
Age-Friendly Care
(4Ms: what Matters Most, Medications, Mentation, Mobility)
(Required.)
1 (Low)
2
3
4
5 (High)
Knowledge
1 (Low)
2
3
4
5 (High)
Confidence
1 (Low)
2
3
4
5 (High)
*
5.
How often will you
now
refer community-based resources to your older patients?
(Required.)
Never
Rarely
Sometimes
Often
Always
Not Applicable (I'm not seeing patients or other reason)
Never
Rarely
Sometimes
Often
Always
Not Applicable (I'm not seeing patients or other reason)
*
6.
Is there anything else you'd like to share with us?
(Required.)
Current Progress,
0 of 6 answered
