October 5th 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
Anticipate and plan in crisis	Anticipate and plan in crisis Very Uncomfortable	Anticipate and plan in crisis Somewhat Uncomfortable	Anticipate and plan in crisis Neutral	Anticipate and plan in crisis Somewhat Comfortable	Anticipate and plan in crisis Very Comfortable
Manage your environment in crisis	Manage your environment in crisis Very Uncomfortable	Manage your environment in crisis Somewhat Uncomfortable	Manage your environment in crisis Neutral	Manage your environment in crisis Somewhat Comfortable	Manage your environment in crisis Very Comfortable
Debrief your team following a critical incident	Debrief your team following a critical incident Very Uncomfortable	Debrief your team following a critical incident Somewhat Uncomfortable	Debrief your team following a critical incident Neutral	Debrief your team following a critical incident Somewhat Comfortable	Debrief your team following a critical incident Very Comfortable

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

	Not at all helpful	Not Very Helpful	Neutral	Helpful	Very Helpful
Deliberate practice for high quality ACLS	Deliberate practice for high quality ACLS Not at all helpful	Deliberate practice for high quality ACLS Not Very Helpful	Deliberate practice for high quality ACLS Neutral	Deliberate practice for high quality ACLS Helpful	Deliberate practice for high quality ACLS Very Helpful
Deliberate practice for high quality Neonatal Resuscitation	Deliberate practice for high quality Neonatal Resuscitation Not at all helpful	Deliberate practice for high quality Neonatal Resuscitation Not Very Helpful	Deliberate practice for high quality Neonatal Resuscitation Neutral	Deliberate practice for high quality Neonatal Resuscitation Helpful	Deliberate practice for high quality Neonatal Resuscitation Very Helpful
Difficult Vascular access (ultrasound/Intraosseous)	Difficult Vascular access (ultrasound/Intraosseous) Not at all helpful	Difficult Vascular access (ultrasound/Intraosseous) Not Very Helpful	Difficult Vascular access (ultrasound/Intraosseous) Neutral	Difficult Vascular access (ultrasound/Intraosseous) Helpful	Difficult Vascular access (ultrasound/Intraosseous) Very Helpful
Improving first pass intubation success	Improving first pass intubation success Not at all helpful	Improving first pass intubation success Not Very Helpful	Improving first pass intubation success Neutral	Improving first pass intubation success Helpful	Improving first pass intubation success Very Helpful
Emergency Front of the Neck Airway	Emergency Front of the Neck Airway Not at all helpful	Emergency Front of the Neck Airway Not Very Helpful	Emergency Front of the Neck Airway Neutral	Emergency Front of the Neck Airway Helpful	Emergency Front of the Neck Airway Very Helpful
Chest Tube Insertion	Chest Tube Insertion Not at all helpful	Chest Tube Insertion Not Very Helpful	Chest Tube Insertion Neutral	Chest Tube Insertion Helpful	Chest Tube Insertion Very Helpful
Ultrasound Guided Central Venous Access	Ultrasound Guided Central Venous Access Not at all helpful	Ultrasound Guided Central Venous Access Not Very Helpful	Ultrasound Guided Central Venous Access Neutral	Ultrasound Guided Central Venous Access Helpful	Ultrasound Guided Central Venous Access Very Helpful
Bipap and Ventilators in the first hour	Bipap and Ventilators in the first hour Not at all helpful	Bipap and Ventilators in the first hour Not Very Helpful	Bipap and Ventilators in the first hour Neutral	Bipap and Ventilators in the first hour Helpful	Bipap and Ventilators in the first hour Very Helpful
Management of the contaminated airway	Management of the contaminated airway Not at all helpful	Management of the contaminated airway Not Very Helpful	Management of the contaminated airway Neutral	Management of the contaminated airway Helpful	Management of the contaminated airway Very Helpful
Vascular access in NRP	Vascular access in NRP Not at all helpful	Vascular access in NRP Not Very Helpful	Vascular access in NRP Neutral	Vascular access in NRP Helpful	Vascular access in NRP Very Helpful
Ultrasound guided nerve blocks	Ultrasound guided nerve blocks Not at all helpful	Ultrasound guided nerve blocks Not Very Helpful	Ultrasound guided nerve blocks Neutral	Ultrasound guided nerve blocks Helpful	Ultrasound guided nerve blocks Very Helpful
Awake intubation techniques	Awake intubation techniques Not at all helpful	Awake intubation techniques Not Very Helpful	Awake intubation techniques Neutral	Awake intubation techniques Helpful	Awake intubation techniques Very Helpful

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?

October 5th Needs Assessment

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