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Preceptorship Post Evaluation
Username
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Name
(Required)
First
Last
Email
(Required)
What is your specialty focus?
(Required)
Select...
Neurology
Neurosurgery
Ophthalmology
Otolaryngology
Pain Management
Physiatry
Aesthetic Medicine
Dermatology
Surgery
Other
Please specify your specialty focus
(Required)
Type of Practice
(Required)
Select...
Hospital Setting
Long-Term Care/Skilled Nursing Facility
Community Setting
HMO/Managed Care
Private Practice/Office Based
Academic Institution
Other
Please specify your type of practice
(Required)
The knowledge and/or skills gained from the course can be applied to my practice.
(Required)
Yes
No
Unsure
How well did this activity meet the following learning objectives?
(Required)
Excellent
Good
Fair
Poor
N/A
Evaluate clinical data, evidence-based recommendations, and practical experience in the use of botulinum neurotoxins for specific conditions, in order to properly assess and select appropriate patients for neurotoxin therapy
Demonstrate best practice procedures and techniques for neurotoxin injections, in order to improve clinical skills and optimize patient outcomes in the management of specific conditions
Apply optimal guidance and localization techniques, in order to improve efficacy in injecting BoNT for treatment of specific conditions
Was the activity effective in improving your knowledge of the topic?
(Required)
Yes
No
What percent of the information which was presented was new to you?
(Required)
(Please enter an integer)
Did you find the data presented clinically meaningful?
(Required)
Yes
No
Do you have remaining unanswered questions about the use of botulinum neurotoxins?
(Please specify)
Did you achieve the learning goals you identified at the beginning of the activity?
(Required)
Yes
No
As a result of participating in this activity, how has your comfort level changed with regard to injecting?
(Required)
Increased a great deal
Increased moderately
Remained the same
Decreased
How has the preceptorship training session impacted your practice ability relative to the following skills/knowledge?
(Required)
Major improvement
Some improvement
No difference
My ability declined
Clinical assessment of patients and injection target selection
Injection technique
Guidance and localization of injections
Evaluation of patient outcomes
As a result of participating in this activity, I will likely make changes to my practice in these categories:
(Required)
Yes
No
Not Sure
Patient evaluation/clinical assessment
Dosing and administration of botulinum neurotoxins
Localization/guidance of botulinum neurotoxin injections
Patient follow-up post injection (may include aftercare/home exercise program)
Other
If you answered other, please specify:
I will make the following additional specific change in my practice.
Please evaluate this activity as a whole:
(Required)
Excellent
Good
Fair
Poor
Program Content
Relevance to my clinical practice
Effectiveness in meeting identified need
Overall, I would rate this activity as:
(Required)
Excellent
Good
Fair
Poor
What was the most effective aspect(s) of this event and why?
What was the least effective aspect(s) of this event?
Mentor Rating
(Required)
Please rate the mentor/preceptor of your preceptor training session
Excellent
Good
Fair
Poor
Overall evaluation of mentor
Knowledge of the subject matter
Effectiveness of didactic presentation
Effectiveness of practical technique demonstration
Commercial Support and Disclosure:
(Required)
Yes
No
Disclosure of faculty relationships with commercial organizations was made available to me before the beginning of the event.
The commercial supporters were acknowledged in the event materials.
Were commercial promotional products displayed in the meeting room?
If you answered “No” to either of the first two questions or “Yes” to the third question, please provide further detail.
Was the environment conducive to learning?
(Required)
Yes
No
How suitable was the audiovisual equipment, technical equipment, and/or computer-based components?
(Required)
Excellent
Good
Fair
Poor
Comments:
What topics would you like to see addressed in future preceptorship programs?
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