Use this tool to gather information periodically from Trainers in your training program and to guide discussions around creating a more equitable, psychologically safe, and respectful training environment.

Trainer:                                 Training Program:                                 Date:                               

1. Please evaluate the following aspects of your training program by circling the appropriate response:






I am actively engaged in my own anti-oppression journey 1 2 3 4 5
I am actively engaged in learning and applying reproductive justice principles 1 2 3 4 5
I consider the ways in which my words and actions may have a different impact depending on the experiences and/or identities of others 1 2 3 4     5
I apologize and make corrections when I have contributed to a harmful learning environment 1 2 3 4 5
I discuss equity issues with trainees 1 2 3 4     5
I speak out against microaggressions 1 2 3 4 5
I use gender neutral language when discussing pregnancy and abortion care 1 2 3 4     5

Strongly Disagree




Strongly Agree

Our trainers are from racially diverse backgrounds 1 2 3 4 5
Our trainers reflect the racial diversity of our patient population and of our trainees 1 2 3 4 5
We provide opportunities for learners to provide anonymous feedback about our training program 1 2 3 4 5
We incorporate learner feedback in an effective manner 1 2 3 4 5

2. What opportunities exist for trainers to reflect on their own identities and how those can impact individual learners and/or the learning environment?


3. What opportunities exist for trainers to gather together to talk about psychological safety (and mutual support?) in the training program?


4. Are there other areas in which the program could enhance its learning environment? (or something like that)


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