November 20/21 SCORE Needs Assessment

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What hospitals do you work in?

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

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	Not at all helpfulMedical Emergency Not at all helpful	Not very helpfulMedical Emergency Not very helpful	NeutralMedical Emergency Neutral	HelpfulMedical Emergency Helpful	Very HelpfulMedical Emergency Very Helpful
Respiratory Emergency	Not at all helpfulRespiratory Emergency Not at all helpful	Not very helpfulRespiratory Emergency Not very helpful	NeutralRespiratory Emergency Neutral	HelpfulRespiratory Emergency Helpful	Very HelpfulRespiratory Emergency Very Helpful
Trauma Emergency	Not at all helpfulTrauma Emergency Not at all helpful	Not very helpfulTrauma Emergency Not very helpful	NeutralTrauma Emergency Neutral	HelpfulTrauma Emergency Helpful	Very HelpfulTrauma Emergency Very Helpful
Airway Emergency	Not at all helpfulAirway Emergency Not at all helpful	Not very helpfulAirway Emergency Not very helpful	NeutralAirway Emergency Neutral	HelpfulAirway Emergency Helpful	Very HelpfulAirway Emergency Very Helpful
Pediatric Emergency	Not at all helpfulPediatric Emergency Not at all helpful	Not very helpfulPediatric Emergency Not very helpful	NeutralPediatric Emergency Neutral	HelpfulPediatric Emergency Helpful	Very HelpfulPediatric Emergency Very Helpful
Toxicologic Emergency	Not at all helpfulToxicologic Emergency Not at all helpful	Not very helpfulToxicologic Emergency Not very helpful	NeutralToxicologic Emergency Neutral	HelpfulToxicologic Emergency Helpful	Very HelpfulToxicologic Emergency Very Helpful
Anesthetic Emergency	Not at all helpfulAnesthetic Emergency Not at all helpful	Not very helpfulAnesthetic Emergency Not very helpful	NeutralAnesthetic Emergency Neutral	HelpfulAnesthetic Emergency Helpful	Very HelpfulAnesthetic Emergency Very Helpful
Cardiac Emergency	Not at all helpfulCardiac Emergency Not at all helpful	Not very helpfulCardiac Emergency Not very helpful	NeutralCardiac Emergency Neutral	HelpfulCardiac Emergency Helpful	Very HelpfulCardiac Emergency Very Helpful
Neonatal Emergency	Not at all helpfulNeonatal Emergency Not at all helpful	Not very helpfulNeonatal Emergency Not very helpful	NeutralNeonatal Emergency Neutral	HelpfulNeonatal Emergency Helpful	Very HelpfulNeonatal Emergency Very Helpful

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	Very UncomfortableAct as an effective leader in crisis Very Uncomfortable	Somewhat UncomfortableAct as an effective leader in crisis Somewhat Uncomfortable	NeutralAct as an effective leader in crisis Neutral	Somewhat ComfortableAct as an effective leader in crisis Somewhat Comfortable	Very ComfortableAct as an effective leader in crisis Very Comfortable
Act as an effective helper in crisis	Very UncomfortableAct as an effective helper in crisis Very Uncomfortable	Somewhat UncomfortableAct as an effective helper in crisis Somewhat Uncomfortable	NeutralAct as an effective helper in crisis Neutral	Somewhat ComfortableAct as an effective helper in crisis Somewhat Comfortable	Very ComfortableAct as an effective helper in crisis Very Comfortable
Maintain effective situational awareness in crisis	Very UncomfortableMaintain effective situational awareness in crisis Very Uncomfortable	Somewhat UncomfortableMaintain effective situational awareness in crisis Somewhat Uncomfortable	NeutralMaintain effective situational awareness in crisis Neutral	Somewhat ComfortableMaintain effective situational awareness in crisis Somewhat Comfortable	Very ComfortableMaintain effective situational awareness in crisis Very Comfortable
Make effective decisions in crisis	Very UncomfortableMake effective decisions in crisis Very Uncomfortable	Somewhat UncomfortableMake effective decisions in crisis Somewhat Uncomfortable	NeutralMake effective decisions in crisis Neutral	Somewhat ComfortableMake effective decisions in crisis Somewhat Comfortable	Very ComfortableMake effective decisions in crisis Very Comfortable
Communicate effectively in crisis	Very UncomfortableCommunicate effectively in crisis Very Uncomfortable	Somewhat UncomfortableCommunicate effectively in crisis Somewhat Uncomfortable	NeutralCommunicate effectively in crisis Neutral	Somewhat ComfortableCommunicate effectively in crisis Somewhat Comfortable	Very ComfortableCommunicate effectively in crisis Very Comfortable
Manage your stress in crisis	Very UncomfortableManage your stress in crisis Very Uncomfortable	Somewhat UncomfortableManage your stress in crisis Somewhat Uncomfortable	NeutralManage your stress in crisis Neutral	Somewhat ComfortableManage your stress in crisis Somewhat Comfortable	Very ComfortableManage your stress in crisis Very Comfortable
Prioritize and manage tasks in crisis	Very UncomfortablePrioritize and manage tasks in crisis Very Uncomfortable	Somewhat UncomfortablePrioritize and manage tasks in crisis Somewhat Uncomfortable	NeutralPrioritize and manage tasks in crisis Neutral	Somewhat ComfortablePrioritize and manage tasks in crisis Somewhat Comfortable	Very ComfortablePrioritize and manage tasks in crisis Very Comfortable

How useful would you find the following airway topics

	Unhelpful	Not very Helpful	Neutral	Helpful	Very Helpful
Optimizing Videolaryngoscopy	UnhelpfulOptimizing Videolaryngoscopy Unhelpful	Not very HelpfulOptimizing Videolaryngoscopy Not very Helpful	NeutralOptimizing Videolaryngoscopy Neutral	HelpfulOptimizing Videolaryngoscopy Helpful	Very HelpfulOptimizing Videolaryngoscopy Very Helpful
Front of the neck access	UnhelpfulFront of the neck access Unhelpful	Not very HelpfulFront of the neck access Not very Helpful	NeutralFront of the neck access Neutral	HelpfulFront of the neck access Helpful	Very HelpfulFront of the neck access Very Helpful
Awake Intubation	UnhelpfulAwake Intubation Unhelpful	Not very HelpfulAwake Intubation Not very Helpful	NeutralAwake Intubation Neutral	HelpfulAwake Intubation Helpful	Very HelpfulAwake Intubation Very Helpful
Pharmacologic techniques for RSI	UnhelpfulPharmacologic techniques for RSI Unhelpful	Not very HelpfulPharmacologic techniques for RSI Not very Helpful	NeutralPharmacologic techniques for RSI Neutral	HelpfulPharmacologic techniques for RSI Helpful	Very HelpfulPharmacologic techniques for RSI 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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November 20/21 SCORE Needs Assessment

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