Preceptorship Post Evaluation | International Neurotoxin Association

Username(Required)

Email(Required)

What is your specialty?(Required)

Please specify your specialty(Required)

Degree(Required)

Please specify your degree(Required)

Type of Practice(Required)

Please specify your type of practice(Required)

Number of years in practice

Self-Assessment

How well did this activity meet the following learning objectives?(Required)

	Excellent	Good	Fair	Poor	N/A
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 assessment 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

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
Adjunctive therapy (may include aftercare/home exercise program, PT, OT)
Assessing/Evaluating patient outcomes
Clinician-clinician communication (treatment team)
Documentation
Patient education
Other

If you answered other, please specify:

I will make the following additional specific change in my practice.

What else would you like to learn?

Mentor Rating(Required)

Please rate the mentor of your preceptorship 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 the previous question or either of the first two questions here or “Yes” to the third question here, please provide further detail.

Post Preceptorship Evaluation

Self-Assessment

Member Login

Preceptorship

Join Our Mailing List

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