September 21st SCORE and ACLS+SCORE Registration

Location:Collingwood General and Marine Hospital, Collingwood

Full Day SCORE consisting of a mixture of high fidelity simulations, skills workshops and Crisis Resource Management Coaching. This course is accredited for 24 Mainpro credits in addition to eligible credits for pre-course work.

ACLS + Half SCORE will consist of an ACLS recertification and a half day of high-fidelity simulation. Because of the lower credit value assigned to the ACLS component, this course is accredited for 17 Mainpro credits in addition to eligible credits for pre-course work.

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 *

• MD Full SCORE ($1200+$156 HST) – $ 1,356.00
• Allied Health Full SCORE ($250+$32.50 HST) – $ 282.50
• Resident Full SCORE (1000+130 HST) – $ 1,130.00
• MD ACLS+Half SCORE ($1000+$130 HST) – $ 1,130.00
• Resident ACLS+ Half SCORE ($900+$117 HST) – $ 1,017.00

Total

$ 0.00

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 workshops would be for your practice *

	Not at all helpful	Not Very Helpful	Neutral	Helpful	Very Helpful
Deliberate practice for high quality Neonatal Resuscitation	Not at all helpfulDeliberate practice for high quality Neonatal Resuscitation Not at all helpful	Not Very HelpfulDeliberate practice for high quality Neonatal Resuscitation Not Very Helpful	NeutralDeliberate practice for high quality Neonatal Resuscitation Neutral	HelpfulDeliberate practice for high quality Neonatal Resuscitation Helpful	Very HelpfulDeliberate practice for high quality Neonatal Resuscitation Very Helpful
Deliberate practice for code blue	Not at all helpfulDeliberate practice for code blue Not at all helpful	Not Very HelpfulDeliberate practice for code blue Not Very Helpful	NeutralDeliberate practice for code blue Neutral	HelpfulDeliberate practice for code blue Helpful	Very HelpfulDeliberate practice for code blue Very Helpful
Deliberate practice for difficult airway algorithm	Not at all helpfulDeliberate practice for difficult airway algorithm Not at all helpful	Not Very HelpfulDeliberate practice for difficult airway algorithm Not Very Helpful	NeutralDeliberate practice for difficult airway algorithm Neutral	HelpfulDeliberate practice for difficult airway algorithm Helpful	Very HelpfulDeliberate practice for difficult airway algorithm Very Helpful
Technical Skills for Airway Management	Not at all helpfulTechnical Skills for Airway Management Not at all helpful	Not Very HelpfulTechnical Skills for Airway Management Not Very Helpful	NeutralTechnical Skills for Airway Management Neutral	HelpfulTechnical Skills for Airway Management Helpful	Very HelpfulTechnical Skills for Airway Management Very Helpful
Chest Tube Insertion	Not at all helpfulChest Tube Insertion Not at all helpful	Not Very HelpfulChest Tube Insertion Not Very Helpful	NeutralChest Tube Insertion Neutral	HelpfulChest Tube Insertion Helpful	Very HelpfulChest Tube Insertion Very Helpful
Central lines and IO access	Not at all helpfulCentral lines and IO access Not at all helpful	Not Very HelpfulCentral lines and IO access Not Very Helpful	NeutralCentral lines and IO access Neutral	HelpfulCentral lines and IO access Helpful	Very HelpfulCentral lines and IO access Very Helpful
Bipap and Ventilators in the first hour	Not at all helpfulBipap and Ventilators in the first hour Not at all helpful	Not Very HelpfulBipap and Ventilators in the first hour Not Very Helpful	NeutralBipap and Ventilators in the first hour Neutral	HelpfulBipap and Ventilators in the first hour Helpful	Very HelpfulBipap and Ventilators in the first hour Very Helpful
Ultrasound guided nerve blocks	Not at all helpfulUltrasound guided nerve blocks Not at all helpful	Not Very HelpfulUltrasound guided nerve blocks Not Very Helpful	NeutralUltrasound guided nerve blocks Neutral	HelpfulUltrasound guided nerve blocks Helpful	Very HelpfulUltrasound guided nerve blocks 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

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
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

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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