SKILLS & EXPERIENCE INVENTORY

Name:                                                 

Training Program:                                                 

1. Please estimate your previous experience with the following procedures:

1st trimester ultrasound dating ☐ None ☐ 1-4 ☐ 5-10 ☐ 11-20 ☐ >20
Pelvic exams for dating ☐ None ☐ 1-4 ☐ 5-10 ☐ 11-20 ☐ >20
IUD insertion ☐ None ☐ 1-4 ☐ 5-10 ☐ 11-20 ☐ >20
Contraceptive implant insertion ☐ None ☐ 1-4 ☐ 5-10 ☐ 11-20 ☐ >20
Medical management of miscarriage ☐ None ☐ 1-4 ☐ 5-10 ☐ 11-20 ☐ >20
Medication abortion ☐ None ☐ 1-4 ☐ 5-10 ☐ 11-20 ☐ >20
Endometrial biopsy ☐ None ☐ 1-4 ☐ 5-10 ☐ 11-20 ☐ >20
Cervical dilation ☐ None ☐ 1-4 ☐ 5-10 ☐ 11-20 ☐ >20
Electric Vacuum Aspiration (EVA) ☐ None ☐ 1-4 ☐ 5-10 ☐ 11-20 ☐ >20
Manual Vacuum Aspiration (MVA) ☐ None ☐ 1-4 ☐ 5-10 ☐ 11-20 ☐ >20

2. Please describe any prior experiences that have helped prepare you for this rotation?

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3.  Provide three reasons why you decided to participate in this training program?

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4. Do you have any hesitations (fears) about participating in this training program or providing abortions? (If so, please explain)

☐  Yes       ☐  No

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5. Aside from technical skills, what else would you like to gain from this training?

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6. Do you anticipate offering procedural abortions in future practice?  ☐  Yes       ☐  No

 

7. Do you anticipate offering medication abortion or management for early pregnancy loss in future practice?

☐  Yes       ☐  No

 

 

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TEACH Abortion Training Curriculum Copyright © 2022 by UCSF Bixby Center for Global Reproductive Health. All Rights Reserved.