COURSE EVALUATION –TOPS (Triad for Optimal Patient Safety)

Class Name: / TOPS Multidisciplinary Teamwork Training
Class Date:
Class Location:

Please rate the following on a scale of 1 to 5 (1=lowest and 5=highest score) [Please circle score]

EVALUATION OF SPECIFIC MODULES /
Lowest Highest
Laying the Foundation Opening / 12345
Safety Video Presentation/Discussion
Quality of Instruction
Quality of Content
Organization
Relevance to my work / 12345
12345
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Healthcare Team Training Presentation
Quality of Instruction
Quality of Content
Organization
Relevance to my work / 12345
12345
12345
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Scenario #1 (Expanding Hematoma)
Quality of Instruction [Instructor: ______]
Quality of Content
Organization
Relevance to my work / 12345
12345
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Scenario #2 (Medication Issue)
Quality of Instruction [Instructor: ______]
Quality of Content
Organization
Relevance to my work / 12345
12345
12345
12345
Plans for the Future: Closing / 12345
OVERALL COURSE EVALUATION CRITERIA / Lowest Highest
  1. Location for training session
/ 12345
  1. Organization and format of training session
/ 12345
  1. Clarity of training objectives
/ 12345
  1. Use of a multidisciplinary group for training
/ 12345
  1. Completion of training objectives
/ 12345
  1. Participation in this training session:
    a. will change the way I communicate with others
    b. will change the way I practice
/ 12345
12345
  1. Overall rating for this training session
/ 12345

8. The biggest obstacle to improving communication and teamwork is ______(fill in blank)

9. What aspects of today’s training weremost useful?

10. What aspects of today’s training wereleast useful?

11. What best describes your role in patient care?
____ Nurse____ Respiratory Therapist
____ Patient Care Assistant____ Physical Therapist
____ Unit Service Coordinator____ Occupational Therapist
____ Intern Physician____ Case Manager
____ Resident Physician____ Social Worker
____ Attending Physician
____ PharmacistOther ______(please list role)
____ Pharmacy Resident

12. How many years have you worked and/or taken care of patients on _____?

____ <2 years____ 2-5 years____ 6-10 years____ >10 years

13. Would you recommend this training session to others? (please circle)YESNO

14. Would you attend a monthly 1-hour multidisciplinary case conference
focusing on medical errors and patient safety? YESNO

15. Do you have a scenario or story you would like to share that might be useful to incorporate into future trainings and/or unit-based multidisciplinary conferences? Please feel free to share it below and/or contact one of the project champions to discuss further.

We welcome any ADDITIONAL COMMENTS or SUGGESTIONSbelow to improve these training

sessions as they will be delievered again in the future. THANK YOU FOR YOUR PARTICIPATION!