TRAINING PROGRAM EVALUATION FORM
For completion by training participants.
Be sure to complete any additional evaluation required by your residency or training program.
Name: _______________________________
Training Program: ________________________
Program Year: __________________________
Date: ________________________________
- Please evaluate the following aspects of your rotation training experience by circling the appropriate response:
Poor | Satisfactory | Good | Excellent | Outstanding | Did not experience | ||
a | Didactic teaching | 1 | 2 | 3 | 4 | 5 | N/A |
b | Syllabus | 1 | 2 | 3 | 4 | 5 | N/A |
c | Clinic orientation | 1 | 2 | 3 | 4 | 5 | N/A |
d | Abortion counseling experience | 1 | 2 | 3 | 4 | 5 | N/A |
e | Medical screening/management | 1 | 2 | 3 | 4 | 5 | N/A |
f | Pelvic examination / sizing | 1 | 2 | 3 | 4 | 5 | N/A |
g | Pain management techniques. | 1 | 2 | 3 | 4 | 5 | N/A |
h | Vacuum aspiration technique | 1 | 2 | 3 | 4 | 5 | N/A |
i | Use of ultrasound | 1 | 2 | 3 | 4 | 5 | N/A |
j | Routine post-abortion care | 1 | 2 | 3 | 4 | 5 | N/A |
k | Opportunities to ask questions | 1 | 2 | 3 | 4 | 5 | N/A |
l | Opportunities to interact with clinic staff | 1 | 2 | 3 | 4 | 5 | N/A |
m | Initial Program Orientation (didactic session at residency or professional training program) | 1 | 2 | 3 | 4 | 5 | N/A |
- What did you like most about the training?
- What did you like least about the training?
- In your opinion, the length of your training was:
[ ] adequate
[ ] too short
[ ] too long
- Did the abortion training rotation adequately prepare you to:
a | Counsel patients about pregnancy options | Yes | No, need more |
b | Counsel patients choosing abortion | Yes | No, need more |
c | Counsel patients about contraceptive options | Yes | No, need more |
d | Obtain informed consent for abortion | Yes | No, need more |
e | Perform accurate pelvic sizing | Yes | No, need more |
f | Perform aspiration procedures under local anesthesia | Yes | No, need more |
g | Perform 1st trimester aspiration abortions with confidence | Yes | No, need more |
h | Manage common abortion complications | Yes | No, need more |
i | Integrate abortion with other health services in your regular practice | Yes | No, need more |
- What additional abortion training opportunities would you like your residency or training program to provide, if any?
- Please evaluate the following training faculty by circling the appropriate responses:
Name of Trainer | Poor | Satisfactory | Good | Excellent | Outstanding | Did not experience |
1 | 2 | 3 | 4 | 5 | NA | |
1 | 2 | 3 | 4 | 5 | NA | |
1 | 2 | 3 | 4 | 5 | NA | |
1 | 2 | 3 | 4 | 5 | NA | |
1 | 2 | 3 | 4 | 5 | NA | |
1 | 2 | 3 | 4 | 5 | NA | |
Other: | 1 | 2 | 3 | 4 | 5 | NA |
- What are your immediate career plans following graduation from this training program?
- What are your long-term career plans?
- Where do you hope to practice after graduating?
[ ] In this state
[ ] In another US state (specify: __________________)
[ ] Outside the US (specify: _________________)
[ ] Don’t know yet
- Do you plan to pursue additional abortion training during or after your residency or training program?
[ ] Yes [ ] No [ ] Undecided
If “Yes,” what additional training? ___________________________________
- Do you anticipate providing aspiration abortions in your post-graduate practice?
[ ] Yes [ ] No [ ] Undecided
- Do you anticipate providing early medication abortions (mifepristone or methotrexate) in your post-graduate practice?
[ ] Yes [ ] No [ ] Undecided
- Since completing the abortion training rotation, has your interest in or commitment to providing abortion services:
[ ] Increased [ ] Decreased [ ] Remained the same
- Has the abortion training rotation influenced your attitudes or opinions about abortion in any positive or negative way? Please explain:
- What suggestions do you have for improving the training program?
- Other comments: