Preceptorship 60-Day Survey

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What is your specialty?(Required)

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Degree(Required)

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Type of Practice(Required)

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Number of years in practice

Learning Strategies

As a result of participating in this preceptorship, please rate the degree to which you are now able to…(Required)

	Major improvement	Some improvement	No difference	My ability declined
Interpret principles of anatomy and pathophysiology for a variety of clinical conditions, in order to assess the need for botulinum neurotoxin treatment
Perform comprehensive and individualized patient assessments, in order to identify appropriate patients for neurotoxin therapy and determine realistic treatment goals
Understand the different toxin formulations, in order to administer a specific therapeutic regimen appropriate for each individual patient
Demonstrate procedures and techniques for neurotoxin injections, including the use of localization and guidance modalities, in order to assure optimal product placement and therapeutic outcomes
Facilitate interaction and improve communication among members of the clinical care team and with the patient, in order to achieve treatment goals

Practice changes as a result of participating in this preceptorship.

As a result of participating in this preceptorship, have you made changes to your practice in the following categories, and if so, how quickly afterward?(Required)

	Yes, within 1 month	Yes, within 2 months	Have not yet implemented this change
Patient evaluation/clinical assessment
Dosing and administration of botulinum neurotoxins
Localization/guidance of botulinum neurotoxin injections
Adjunctive therapy (may include aftercare/home exercise program, PT, OT)
Assessing/Evaluating patient outcomes
Clinician-clinician communication (treatment team)
Documentation
Patient education

Other comments regarding change in practice or patient health outcomes as a result of participating in this preceptorship:

Learning Strategies

Practice changes as a result of participating in this preceptorship.

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