Qualtrics Survey | Qualtrics Experience Management

Month & Year of Rotation:

Please select your category:

The Toxicology Service / The Rotation:

The Toxicology Service / The Rotation:
	Agree	Partially Agree	Partially Disagree	Disagree	N/A
You were informed of the objectives of the rotation	Agree	Partially Agree	Partially Disagree	Disagree	N/A
You received the course guide prior to the rotation	Agree	Partially Agree	Partially Disagree	Disagree	N/A
Your work hours were <80 hours/week	Agree	Partially Agree	Partially Disagree	Disagree	N/A
You were treated with respect	Agree	Partially Agree	Partially Disagree	Disagree	N/A
You found the Picture Projects to be useful	Agree	Partially Agree	Partially Disagree	Disagree	N/A
You thought the team functioned well	Agree	Partially Agree	Partially Disagree	Disagree	N/A
You thought the didactic sessions were useful	Agree	Partially Agree	Partially Disagree	Disagree	N/A
The Poison Center was easy to find	Agree	Partially Agree	Partially Disagree	Disagree	N/A
The Poison Center had appropriate facilities	Agree	Partially Agree	Partially Disagree	Disagree	N/A
You found the Poison Center rounds useful in your education	Agree	Partially Agree	Partially Disagree	Disagree	N/A

Please rate the fellows on a scale of 1 - 5 (1 is low; 5 is high; N/A is not applicable)

Please rate the fellows on a scale of 1 - 5 (1 is low; 5 is high; N/A is not applicable)
	Frank Dicker


	5 = High	4	3	2	1 = Low	N/A
Available and interested
Provides support during rounds
Has an excellent fund of knowledge
Teaching skills (information is clear, concise; makes an effort to provide education; provides feedback)
Allows you to evaluate patients and form a plan
Provides appropriate supervision
Uses effective listening, questioning, nonverbal, and explanatory skills
You were treated with respect
Demonstrates sensitivity to patients and colleagues
Adheres to ethical principles of patient care (confidentiality, informed consent, responsive to the needs of others)
Identifies areas for improvement
Learns from errors and uses them to improve system or care
Functions well within the team
Applies cost effective care
Advocates for quality patient care
Uses other hospital resources efficiently
Returns calls or pages promptly
Conducts rounds in a professional manner

General Comments regarding fellow - Frank Dicker:

Please rate the fellows on a scale of 1 - 5 (1 is low; 5 is high; N/A is not applicable)

Please rate the fellows on a scale of 1 - 5 (1 is low; 5 is high; N/A is not applicable)
	Carleigh Hebbard


	5 = High	4	3	2	1 = Low	N/A
Available and interested
Provides support during rounds
Has an excellent fund of knowledge
Teaching skills (information is clear, concise; makes an effort to provide education; provides feedback)
Allows you to evaluate patients and form a plan
Provides appropriate supervision
Uses effective listening, questioning, nonverbal, and explanatory skills
You were treated with respect
Demonstrates sensitivity to patients and colleagues
Adheres to ethical principles of patient care (confidentiality, informed consent, responsive to the needs of others)
Identifies areas for improvement
Learns from errors and uses them to improve system or care
Functions well within the team
Applies cost effective care
Advocates for quality patient care
Uses other hospital resources efficiently
Returns calls or pages promptly
Conducts rounds in a professional manner

General Comments regarding fellow - Carleigh Hebbard

Please rate the fellows on a scale of 1 - 5 (1 is low; 5 is high; N/A is not applicable)

Please rate the fellows on a scale of 1 - 5 (1 is low; 5 is high; N/A is not applicable)
	Kim-Long Nguyen


	5 = High	4	3	2	1 = Low	N/A
Available and interested
Provides support during rounds
Has an excellent fund of knowledge
Teaching skills (information is clear, concise; makes an effort to provide education; provides feedback)
Allows you to evaluate patients and form a plan
Provides appropriate supervision
Uses effective listening, questioning, nonverbal, and explanatory skills
You were treated with respect
Demonstrates sensitivity to patients and colleagues
Adheres to ethical principles of patient care (confidentiality, informed consent, responsive to the needs of others)
Identifies areas for improvement
Learns from errors and uses them to improve system or care
Functions well within the team
Applies cost effective care
Advocates for quality patient care
Uses other hospital resources efficiently
Returns calls or pages promptly
Conducts rounds in a professional manner

General Comments regarding fellow - Kim-Long Nguyen

Please rate the fellows on a scale of 1 - 5 (1 is low; 5 is high; N/A is not applicable)

Please rate the fellows on a scale of 1 - 5 (1 is low; 5 is high; N/A is not applicable)
	Alexander Lazar


	5 = High	4	3	2	1 = Low	N/A
Available and interested
Provides support during rounds
Has an excellent fund of knowledge
Teaching skills (information is clear, concise; makes an effort to provide education; provides feedback)
Allows you to evaluate patients and form a plan
Provides appropriate supervision
Uses effective listening, questioning, nonverbal, and explanatory skills
You were treated with respect
Demonstrates sensitivity to patients and colleagues
Adheres to ethical principles of patient care (confidentiality, informed consent, responsive to the needs of others)
Identifies areas for improvement
Learns from errors and uses them to improve system or care
Functions well within the team
Applies cost effective care
Advocates for quality patient care
Uses other hospital resources efficiently
Returns calls or pages promptly
Conducts rounds in a professional manner

General Comments regarding fellow - Alexander Lazar:

Please rate the attendings you had interactions with.

~ On a scale of 1 - 5 (1 is low; 5 is high; N/A is not applicable) ~

<div>Please rate the attendings you had interactions with.</div><div>~ On a scale of 1 - 5 (1 is low; 5 is high; N/A is not applicable) ~<br></div>
	LISS						MULLINS						BAUMGARTNER						BERG


	5	4	3	2	1	N/A	5	4	3	2	1	N/A	5	4	3	2	1	N/A	5	4	3	2	1	N/A
Available and interested
Provides support during rounds
Has an excellent fund of knowledge
Teaching skills (information is clear, concise; makes an effort to provide education; provides feedback)
Allows you to evaluate patients and form a plan
Provides appropriate supervision
Uses effective listening, questioning, nonverbal, and explanatory skills
You were treated with respect
Demonstrates sensitivity to patients and colleagues
Adheres to ethical principles of patient care (confidentiality, informed consent, responsive to the needs of others)
Identifies areas for improvement
Learns from errors and uses them to improve system or care
Functions well within the team
Applies cost effective care
Advocates for quality patient care
Uses other hospital resources efficiently
Returns calls or pages promptly
Conducts rounds in a professional manner

General Comments regarding attendings: