Appendix 7 – Trainee Course Evaluation

May 18, 2015

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Appendix 7 Evaluation of the Course by the trainee

We welcome your comments about the time you have spent training with us. Please complete the following details so that we can continue to offer the best service possible. Please pass them to the program coordinator after completion of the course.
Please place a check mark in the appropriate box for your answer.  When you are finished with this side please complete the sections located on the back of this form


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* Indicates required question
Name of the Centre *
Choose
Trivandrum Institute of Palliative Sciences, Thiruvananthapuram
MNJ Institute of Oncology, Hyderabad
Tata Memorial Hospital, Mumbai
Gujarat Cancer Research Institute, Ahmedabad
Cipla Palliative Care and Training Center, Pune
CanSupport, New Delhi
Kasturba Medical College, Manipal, Karnataka
 Name of the Trainee *
Your answer
Profession - Student *
Required
 POSTINGS AND ROTATIONS
MM
/
DD
/
YYYY
Please answer the following questions
Do you feel that the number of patients available for learning about palliative care was adequate in the in-patient setting? *
Do you feel that the number of patients available for learning about palliative care, was adequate in the out-patient setting? *
Do you feel that the number of visits available for learning about palliative care, was adequate in the home based care setting? *
Do you feel that duration of IACA-TIPS course is appropriate? YES/NO (If your answer is No then please attempt next question)
Clear selection
If NO then what should be the ideal duration of the course
1 = STRONGLY DISAGREE                                                                     2 = SOMEWHAT DISAGREE                                                                       3 = NEITHER AGREE OR DISAGREE                                                      4 = SOMEWHAT AGREE                                                                         5 = STRONGLY AGREE
Were your objectives for doing the course met? *
STRONGLY DISAGREE
STRONGLY AGREE
Do you feel comfortable assessing and managing symptoms of patients with advanced disease? *
STRONGLY DISAGREE
STRONGLY AGREE
Do you feel the information gained will be useful in your practice? *
STRONGLY DISAGREE
STRONGLY AGREE
Would you recommend this course to others? *
STRONGLY DISAGREE
STRONGLY AGREE
FACULTY
How prepared was the faculty on the topic? *
STRONGLY DISAGREE
STRONGLY AGREE
How were the presentations? *
STRONGLY DISAGREE
STRONGLY AGREE
Did the faculty respond well to your questions? *
STRONGLY DISAGREE
STRONGLY AGREE
Did you feel that you were mentored/ helped well by the staff & the faculty? *
STRONGLY DISAGREE
STRONGLY AGREE
Overall rating of instructors *
STRONGLY DISAGREE
STRONGLY AGREE
THE CENTER
Were the administrative staff helpful and approachable? *
STRONGLY DISAGREE
STRONGLY AGREE
Was the environment in the clinics, ward and class rooms conducive to learning *
STRONGLY DISAGREE
STRONGLY AGREE
Were the course materials helpful? *
STRONGLY DISAGREE
STRONGLY AGREE
Was the orientation to the department satisfactory? *
STRONGLY DISAGREE
STRONGLY AGREE
SUMMARY COMMENTS
What did you like best about the program? *
Your answer
What, if anything, would you have improved on the course? *
Your answer
From the learning gained during this course, please outline future plans in context of your immediate future *
Vision
Your answer
*
1. Place / Institution
Your answer
*
2. What are your short term Goals?
Your answer
*
3. What are your long term Goals?
Your answer
*
4. What help or mentoring would be useful to you to help towards your vision?
Your answer
Thank you very much for your time and responses. We are trying to incorporate your feedbacks to support development of  Palliative Care services with good standards and quality in different parts of the country
If you may, please give us your contact details for future correspondence
Your answer
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Donations
Every dollar you donate will facilitate the various IACA projects and help train fellows in palliative care or develop expertise in areas of unmet need and fund the entire care of kids with cancer. All contributions are tax deductible, the fullest extent as allowed by IRS.