Manitoulin 2022 Needs Assessment

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Which of the following make up your current/future practice. (Select all that apply) *

How would you rate your comfort with the following non-technical Crisis Resource Management Skills *

	Very Uncomfortable	Somewhat Uncomfortable	Neutral	Somewhat Comfortable	Very Comfortable
Act as an effective leader in crisis	Act as an effective leader in crisis Very Uncomfortable	Act as an effective leader in crisis Somewhat Uncomfortable	Act as an effective leader in crisis Neutral	Act as an effective leader in crisis Somewhat Comfortable	Act as an effective leader in crisis Very Comfortable
Act as an effective helper in crisis	Act as an effective helper in crisis Very Uncomfortable	Act as an effective helper in crisis Somewhat Uncomfortable	Act as an effective helper in crisis Neutral	Act as an effective helper in crisis Somewhat Comfortable	Act as an effective helper in crisis Very Comfortable
Maintain effective situational awareness in crisis	Maintain effective situational awareness in crisis Very Uncomfortable	Maintain effective situational awareness in crisis Somewhat Uncomfortable	Maintain effective situational awareness in crisis Neutral	Maintain effective situational awareness in crisis Somewhat Comfortable	Maintain effective situational awareness in crisis Very Comfortable
Make effective decisions in crisis	Make effective decisions in crisis Very Uncomfortable	Make effective decisions in crisis Somewhat Uncomfortable	Make effective decisions in crisis Neutral	Make effective decisions in crisis Somewhat Comfortable	Make effective decisions in crisis Very Comfortable
Communicate effectively in crisis	Communicate effectively in crisis Very Uncomfortable	Communicate effectively in crisis Somewhat Uncomfortable	Communicate effectively in crisis Neutral	Communicate effectively in crisis Somewhat Comfortable	Communicate effectively in crisis Very Comfortable
Manage your stress in crisis	Manage your stress in crisis Very Uncomfortable	Manage your stress in crisis Somewhat Uncomfortable	Manage your stress in crisis Neutral	Manage your stress in crisis Somewhat Comfortable	Manage your stress in crisis Very Comfortable
Prioritize and manage tasks in crisis	Prioritize and manage tasks in crisis Very Uncomfortable	Prioritize and manage tasks in crisis Somewhat Uncomfortable	Prioritize and manage tasks in crisis Neutral	Prioritize and manage tasks in crisis Somewhat Comfortable	Prioritize and manage tasks in crisis Very Comfortable

Please indicate how helpful each of the following simulation themes would be for your practice *

	Not at all helpful	Not very helpful	Neutral	Helpful	Very Helpful
Medical Emergency	Medical Emergency Not at all helpful	Medical Emergency Not very helpful	Medical Emergency Neutral	Medical Emergency Helpful	Medical Emergency Very Helpful
Respiratory Emergency	Respiratory Emergency Not at all helpful	Respiratory Emergency Not very helpful	Respiratory Emergency Neutral	Respiratory Emergency Helpful	Respiratory Emergency Very Helpful
Trauma Emergency	Trauma Emergency Not at all helpful	Trauma Emergency Not very helpful	Trauma Emergency Neutral	Trauma Emergency Helpful	Trauma Emergency Very Helpful
Airway Emergency	Airway Emergency Not at all helpful	Airway Emergency Not very helpful	Airway Emergency Neutral	Airway Emergency Helpful	Airway Emergency Very Helpful
Pediatric Emergency	Pediatric Emergency Not at all helpful	Pediatric Emergency Not very helpful	Pediatric Emergency Neutral	Pediatric Emergency Helpful	Pediatric Emergency Very Helpful
Toxicologic Emergency	Toxicologic Emergency Not at all helpful	Toxicologic Emergency Not very helpful	Toxicologic Emergency Neutral	Toxicologic Emergency Helpful	Toxicologic Emergency Very Helpful
Anesthetic Emergency	Anesthetic Emergency Not at all helpful	Anesthetic Emergency Not very helpful	Anesthetic Emergency Neutral	Anesthetic Emergency Helpful	Anesthetic Emergency Very Helpful
Cardiac Emergency	Cardiac Emergency Not at all helpful	Cardiac Emergency Not very helpful	Cardiac Emergency Neutral	Cardiac Emergency Helpful	Cardiac Emergency Very Helpful
Neonatal Emergency	Neonatal Emergency Not at all helpful	Neonatal Emergency Not very helpful	Neonatal Emergency Neutral	Neonatal Emergency Helpful	Neonatal Emergency Very Helpful

Do you have any other signifiant educational goals that may be amenable to a simulation experience?

Are there any simulation cases that you have already done that you would not want to repeat?

Are there an cases/scenarios that may trigger you in an unpleasant way and should therefore be avoided?

Do you have any food allergies or dietary requirements?

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Manitoulin 2022 Needs Assessment

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