Intervention Evaluation Form Survey

Please specify how well the following objectives were met:

1) Discuss the importance of becoming a Good Prescriber.

2) Identify barriers and facilitators for prescribing, including the six-steps.

3) Offer additional resources for further development of competency

	Excellent	Good	Fair	Poor	N/A
Discussion of the importance of good prescribing.	Discussion of the importance of good prescribing. Excellent	Discussion of the importance of good prescribing. Good	Discussion of the importance of good prescribing. Fair	Discussion of the importance of good prescribing. Poor	Discussion of the importance of good prescribing. N/A
Identification of barriers and facilitators for prescribing.	Identification of barriers and facilitators for prescribing. Excellent	Identification of barriers and facilitators for prescribing. Good	Identification of barriers and facilitators for prescribing. Fair	Identification of barriers and facilitators for prescribing. Poor	Identification of barriers and facilitators for prescribing. N/A
Introduction of the WHO six-steps	Introduction of the WHO six-steps Excellent	Introduction of the WHO six-steps Good	Introduction of the WHO six-steps Fair	Introduction of the WHO six-steps Poor	Introduction of the WHO six-steps N/A
Infographic as a teaching tool	Infographic as a teaching tool Excellent	Infographic as a teaching tool Good	Infographic as a teaching tool Fair	Infographic as a teaching tool Poor	Infographic as a teaching tool N/A
Overall design and appeal of the infographic	Overall design and appeal of the infographic Excellent	Overall design and appeal of the infographic Good	Overall design and appeal of the infographic Fair	Overall design and appeal of the infographic Poor	Overall design and appeal of the infographic N/A
Likelihood that I will seek more information on becoming a Good Prescriber.	Likelihood that I will seek more information on becoming a Good Prescriber. Excellent	Likelihood that I will seek more information on becoming a Good Prescriber. Good	Likelihood that I will seek more information on becoming a Good Prescriber. Fair	Likelihood that I will seek more information on becoming a Good Prescriber. Poor	Likelihood that I will seek more information on becoming a Good Prescriber. N/A
Instructor knowledge of the subject matter.	Instructor knowledge of the subject matter. Excellent	Instructor knowledge of the subject matter. Good	Instructor knowledge of the subject matter. Fair	Instructor knowledge of the subject matter. Poor	Instructor knowledge of the subject matter. N/A

Excellent

Good

Fair

Poor

N/A

Discussion of the importance of good prescribing.

Discussion of the importance of good prescribing. Excellent

Discussion of the importance of good prescribing. Good

Discussion of the importance of good prescribing. Fair

Discussion of the importance of good prescribing. Poor

Discussion of the importance of good prescribing. N/A

Identification of barriers and facilitators for prescribing.

Identification of barriers and facilitators for prescribing. Excellent

Identification of barriers and facilitators for prescribing. Good

Identification of barriers and facilitators for prescribing. Fair

Identification of barriers and facilitators for prescribing. Poor

Identification of barriers and facilitators for prescribing. N/A

Introduction of the WHO six-steps

Introduction of the WHO six-steps Excellent

Introduction of the WHO six-steps Good

Introduction of the WHO six-steps Fair

Introduction of the WHO six-steps Poor

Introduction of the WHO six-steps N/A

Infographic as a teaching tool

Infographic as a teaching tool Excellent

Infographic as a teaching tool Good

Infographic as a teaching tool Fair

Infographic as a teaching tool Poor

Infographic as a teaching tool N/A

Overall design and appeal of the infographic

Overall design and appeal of the infographic Excellent

Overall design and appeal of the infographic Good

Overall design and appeal of the infographic Fair

Overall design and appeal of the infographic Poor

Overall design and appeal of the infographic N/A

Likelihood that I will seek more information on becoming a Good Prescriber.

Likelihood that I will seek more information on becoming a Good Prescriber. Excellent

Likelihood that I will seek more information on becoming a Good Prescriber. Good

Likelihood that I will seek more information on becoming a Good Prescriber. Fair

Likelihood that I will seek more information on becoming a Good Prescriber. Poor

Likelihood that I will seek more information on becoming a Good Prescriber. N/A

Instructor knowledge of the subject matter.

Instructor knowledge of the subject matter. Excellent

Instructor knowledge of the subject matter. Good

Instructor knowledge of the subject matter. Fair

Instructor knowledge of the subject matter. Poor

Instructor knowledge of the subject matter. N/A

Intervention Evaluation Form

Intervention Evaluation Form

Question Title

* 1. Please evaluate this intervention: