1. Preceptor Development: Feedback and Evaluation of Students

We are pleased that you participated in one of our AHEC educational programs. Please take the time to fill out this evaluation survey, so that we can improve future programs.

For continuing education certificate, completion and submission of evaluation is required. Continuing education certificates will be mailed to the participants.

* 1. Please provide your name and email address so that we may identify registrants that complete the evaluation survey for continuing education certificates. We will send reminder emails to those that do not complete the evaluation survey.

* 2. Please indicate your professional degree.

* 3. Please indicate your birth year:

* 4. Did you participate in the AHEC/HealthTecDL program from your organization's facilities?

* 5. If yes, were there other individuals who viewed the presentation with you?

* 6. If yes, and they were not pre-registered, please provide the names and email addresses of these people, so we may have a complete record of participants.

* 7. Choose the percent that most closely corresponds with your satisfaction:

  100% 90% 80% 70% 60% 50% 40% 30% 20% 10%
I was satisfied with the educational value of this activity.
The content will positively impact the care delivered to my patients.
The learning will change the way I currently practice.

* 8. Did the format of the program / activity allow you to achieve your desired results?

* 9. Please rate the following aspects of the program content:

  Strongly Disagree Disagree Neutral Agree Strongly Agree
Activity met the stated objectives.
Presentation was scientific and objective.
Presentation was free from commercial bias.
Facilities, arrangements and scheduling was conducive to my learning.
Audience response system was interactive and promoted learning.

* 10. Assess the change in your knowledge/skill level (1=low and 5=high).

  1 2 3 4 5
Knowledge/skill level before the course
Knowledge/skill level after the course
Rate your level of mastery of the material

* 11. Will the knowledge/skills obtained during this course positively effect your practice?

* 12. What factors outside of your control may prevent you from using this information to make changes in your current practice?

* 13. How do you rate the quality of instruction?

  Strongly Disagree Disagree Neutral Agree Strongly Agree
Instructional materials were well organized.
Instructional methods illustrated the concepts well.
If slides were presented, they will be useful references.
References and resources provided will assist me.

* 14. How do you rate the quality of presentation?

  Strongly Disagree Disagree Neutral Agree Strongly Agree
Presenter was clear and to the point.
Presenter demonstrated mastery of the topic.
Methods used to present the materials held my attention.
Presenter was responsive to questions.

* 15. Objectives for Feedback and Evaluation of Students (T. Andrew Albritton, MD; Christopher White, MD)

  Strongly disagree Disagree Neutral Agree Strongly Agree
Demonstrated knowledge of the subject matter
Presented in a manner that facilitates learning
Objective achieved: Describe and apply the RIME model of evaluation
Objective achieved: Describe and apply the principles of feedback

* 16. What one thing would you recommend that we change to improve content and/or presentation?

* 17. Please rate the following aspects of the distance-based network:

  Very Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied
Ease of access to program.
Quality of the video/slides.
Quality of the audio.
Degree of interactivity.

* 18. Please describe any difficulties that you encountered in participating in the program from your location.

* 19. Were the faculty relationships disclosed during the introduction to the course? (If you were not present for the Introduction portion please skip this question, do not select no.)

* 20. What one thing would you recommend that we change to the distance based aspect of the program?

* 21. What additional topics would you like to see offered?

* 22. May we contact you approximately six months from now to determine the effectiveness of the learning topics on your practice?