November SCORE Course Registration

Cancellation Policy

• Cancellations made at least 30 days in advance will receive a refund less a 25% administrative fee.
• Cancellations made between 29 and 15 days in advance will receive a refund less a 50% administrative fee
• Cancellations made 14 days in advance or less will receive a course credit of 50% of their registration fee towards a future SCORE CME activity.

Name *

First

Last

Email *

Designation *

• Practicing Physician
• Resident Physician
• RN/RPN
• Physician Assistant
• Respiratory Therapist
• Other

Please Specify

Select Appropriate Course Fee *

• November 20th SCORE Airway MD ($1295+HST) – $1,463.35
• November 21 SCORE Classic MD ($1295+HST) – $1,463.35
• November 20/21 2 Day Discount ($2400+HST) – $2,712.00
• November 20 Allied Health SCORE Airway ($500+HST) – $565.00
• November 21 Allied Health SCORE ($500+HST) – $565.00
• November 20 SCORE Airway Resident(950+123.50 HST) – $1,073.50

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Total

$0.00

Select Payment Method *

• E-transfer
• Credit Card

E-Transfers can be made to admin@scorecme.com Use the password scorecme2024

Stripe Credit Card

Card

Name on Card

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

• Office Family Medicine
• Hospital Inpatient Care
• Emergency Medicine
• Anesthesia
• Obstetrics
• Neonatal Resuscitation

NEEDS ASSEMENT-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

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
Technical skills for Bag Mask Ventilation, LMA insertion and Direct Laryngoscopy	Not at all helpfulTechnical skills for Bag Mask Ventilation, LMA insertion and Direct Laryngoscopy Not at all helpful	Not very helpfulTechnical skills for Bag Mask Ventilation, LMA insertion and Direct Laryngoscopy Not very helpful	NeutralTechnical skills for Bag Mask Ventilation, LMA insertion and Direct Laryngoscopy Neutral	HelpfulTechnical skills for Bag Mask Ventilation, LMA insertion and Direct Laryngoscopy Helpful	Very HelpfulTechnical skills for Bag Mask Ventilation, LMA insertion and Direct Laryngoscopy Very Helpful
Technical skills for videolaryngoscopy	Not at all helpfulTechnical skills for videolaryngoscopy Not at all helpful	Not very helpfulTechnical skills for videolaryngoscopy Not very helpful	NeutralTechnical skills for videolaryngoscopy Neutral	HelpfulTechnical skills for videolaryngoscopy Helpful	Very HelpfulTechnical skills for videolaryngoscopy Very Helpful
Front of the Neck Access	Not at all helpfulFront of the Neck Access Not at all helpful	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 techniques	Not at all helpfulAwake intubation techniques Not at all helpful	Not very helpfulAwake intubation techniques Not very helpful	NeutralAwake intubation techniques Neutral	HelpfulAwake intubation techniques Helpful	Very HelpfulAwake intubation techniques 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?

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