ICPCN e-learning evaluation form – Introduction to Palliative Care in Children 2

Section 1: Demographic Data

Thank you very much for taking part in the ICPCN’s e-learning programme on the introduction to palliative care in children. We would like to get your feedback on the course to help us to make improvements in the future.

Please can you complete the following evaluation form for us and be as open and honest as possible – you will not be asked to put your name on the evaluation but we would like to get other information about you such as the country in which you work.

The evaluation has three sections:

Section 1: In this section demographic data/ information will be asked of the respondent.
Section 2: This section will include questions on the course itself.
Section 3: This section is very short and asks about ICPCN membership and contact details.

The evaluation form should take about 10 minutes to complete, but may take longer depending on the speed of your internet connection. It is not possible to save it and come back to it later so you need to ensure that you have time to complete it.

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* 1. In which country do you work?

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* 2. In which region is the country where you work?

sub-Saharan Africa

North Africa

North America

Latin America

Caribbean

Asia

Europe

Middle East

Oceania

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* 3. In which country have you been accessing the elearning materials?

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* 4. What is your Professional Background?

Counsellor

Doctor

Nurse

Religious Leader

Social Worker

Teacher

Other

Other (Please specify)

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* 5. What is your current job?

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* 6. How did you hear about this e-learning programme?

I was asked to complete it by my manager

I was sent information about it through an email

I read about it in the ICPCN Newsletter

I read about it on the ICPCN website

I read about it on the ICPCN elearning leaflet

Other

Other (Please specify)

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* 7. Did you undertake the clinical placement part of the course?

Yes

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* 8. If you answered ‘Yes’ in question 7, where did you do your clinical placement?

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* 9. What is your first language?

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* 10. Is English spoken in your country?

Yes

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* 11. Would you consider yourself to be fluent in English?

Yes

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* 12. Where did you access the internet to complete the course?

At home

At work

At an internet cafe

Other

Other (Please specify)

25% of survey complete.