Preceptorship Post Evaluation

Username(Required)

Email(Required)

What is your specialty focus?(Required)

Please specify your specialty focus(Required)

Type of Practice(Required)

Please specify your type of practice(Required)

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

What percent of the information which was presented was new to you?(Required)

(Please enter an integer)

Do you have remaining unanswered questions about the use of botulinum neurotoxins?

(Please specify)

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)

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

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.

Comments:

What topics would you like to see addressed in future preceptorship programs?

	Excellent	Good	Fair	Poor
Overall evaluation of mentor
Knowledge of the subject matter
Effectiveness of didactic presentation
Effectiveness of practical technique demonstration