STeLI Simulation Facilitation - Pre-course Questionnaire

All questions marked with an '*' are mandatory:

* How did you hear about the course:

Please select a valid item. Please select an item.

Other, please Specify:

* Profession:

Please select a valid item. Please select an item.

* Speciality:

Please select a valid item. Please select an item.

* Grade:

Please select a valid item. Please select an item.

If profession is Allied Health, please specify:

* Previous teaching experience:

Small Groups
Formal Lectures
None
Other, please specify:
Please make a selection.

* Formal teaching qualification:

PHD
Master
Bachelor
Diploma
Certificate
Generic Instructor Course
None
Other, please specify:
Please make a selection.

* How much time in your job is dedicated to
teaching per month:

None
1 day
3 days
1 week
Full Time
Other, please specify:
Please make a selection.

* What factors influenced
your application for this course:

Personal Development
Job Requirement
Advised from senior colleague
Help current program
Interest to initiate Simulation in own hospital
Other, please specify:
Please make a selection.

Ratings:

Not at all

Somewhat

Very Much

* Are you aware of different teaching styles
in different groups of learners:

5 Please make a selection.

* How confident are you
in facilitating debriefs:

5 Please make a selection.

* How confident do you feel
about designing your own scenarios:

5 Please make a selection.

* How confident do you feel
about delivering a simulation course:

5 Please make a selection.

* Have you previously been involved
with Simulation:

Yes NoPlease make a selection.

* Have you been a candidate
on any of the following courses:

Crisis Resource Management / Human Factors
Anaesthetic Simulation
Obstetric Simulation
Critical Care
Paediatric Simulation
Foundation Year Training
None
Please make a selection.

* Have you ever been an Instructor
on any of the following course:

Crisis Resource Management / Human Factors
Anaesthetic Simulation
Obstetric Simulation
Critical Care
Paediatric Simulation
Foundation Year Training
None
Please make a selection.

* Does your current hospital have a patient simulator manikin:

Yes

NoPlease make a selection.

If YES, how do you use the manikin:

If NO, Is your hospital
planning to purchase manikin:

Full Immersion
Skills Training
Crisis Resource Management / Human Factors
Resuscitation Training
In-situ / Mobile Simulation
Not Applicable
Other, please specify:

Yes No

If YES, do you have a designated area:

Yes No

* How many faculty members are currently trained
to facilitate simulation courses at your hospital:

Please select an item. Please select a valid item.

* What are the main challenges for you
in delivering high fidelity simulation:

Financial
Structural
Time
Departmental
Inadequate Faculty
None
Please make a selection.