Student Pre Rotation Survey

1. Default Section

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* 1. Age:

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* 2. Gender:

Male

Female

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* 3. Medical School:

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* 4. Prior health profession experience:

EMT

Paramedic

Nurse

Tech

Other (please specify)

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* 5. Did you complete?

COMLEX

USMLE

Both

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* 6. Are you entering the ENRICHED TRACK or CORE TRACK?

ENRICHED TRACK

CORE TRACK

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* 7. If you chose ENRICHED, what was your reason for choosing it?

Additional simulation

More didactic lectures

Autopsy Day

Faculty Mentoring

Ultrasound

Toxicology

Other (please specify)

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* 8. How did you hear about the LVHN EM rotation?

Word of mouth

Website

Prior students that completed rotation

Rotated on another service at LVHN

Other (please specify)

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* 9. List the number of prior EM rotations:

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* 10. List the programs you have rotated at thus far:

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* 11. Are you entering the AOA match, ACGME match, or both?

AOA

ACGME

Both

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* 12. What type of residency are you entering?

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* 13. If entering EM residency, are you planning on performing a fellowship?

Yes

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* 14. If so, which would be the most likely (only one):

Critical Care

EMS

Toxicology

Administration

Ultrasound

Research

Other (please specify)

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* 15. List the number of the following procedures you have performed:

IV cannulation:

NGT placement:

Foley catheter placement:

Orthopedic splinting:

Epistaxis management:

Intubation:

Lumbar puncture:

Central Line:

Chest tube:

Reduction of major dislocated joint:

Basic wound management:

Abcess I&D:

Performing a 12 lead EKG:

Transcutaneous pacing:

Question Title

* 16. How comfortable do you feel performing the following procedures without assistance?
1=extremely comfortable
2=very comfortable
3=comfortable
4=somewhat comfortable
5=not comfortable at all

IV cannulation:

NGT placement:

Foley catheter placement:

Orthopedic splinting:

Epistaxis management:

Intubation:

Lumbar puncture:

Central Line:

Chest tube:

Reduction of major dislocated joint:

Basic wound management:

Abcess I&D:

Performing a 12 lead EKG:

Transcutaneous pacing:

Question Title

* 1. Age:

Question Title

* 2. Gender:

Question Title

* 3. Medical School:

Question Title

* 4. Prior health profession experience:

Question Title

* 5. Did you complete?

Question Title

* 6. Are you entering the ENRICHED TRACK or CORE TRACK?

Question Title

* 7. If you chose ENRICHED, what was your reason for choosing it?

Question Title

* 8. How did you hear about the LVHN EM rotation?

Question Title

* 9. List the number of prior EM rotations:

Question Title

* 10. List the programs you have rotated at thus far:

Question Title

* 11. Are you entering the AOA match, ACGME match, or both?

Question Title

* 12. What type of residency are you entering?

Question Title

* 13. If entering EM residency, are you planning on performing a fellowship?

Question Title

* 14. If so, which would be the most likely (only one):

Question Title

* 15. List the number of the following procedures you have performed:

Question Title

* 16. How comfortable do you feel performing the following procedures without assistance? 1=extremely comfortable2=very comfortable3=comfortable4=somewhat comfortable5=not comfortable at all

* 16. How comfortable do you feel performing the following procedures without assistance?
1=extremely comfortable
2=very comfortable
3=comfortable
4=somewhat comfortable
5=not comfortable at all