TRAINING PROGRAM EVALUATION FORM

For completion by training participants.

Be sure to complete any additional evaluation required by your residency or training program.

Name: _______________________________

Training Program: ________________________

Program Year: __________________________

Date: ________________________________

  1. Please evaluate the following aspects of your training experience by circling the appropriate response:
Poor Satisfactory Good Excellent Outstanding Did not experience
a Didactic teaching 1 2 3 4 5 N/A
b Syllabus 1 2 3 4 5 N/A
c Clinic orientation 1 2 3 4 5 N/A
d Abortion counseling experience 1 2 3 4 5 N/A
e Medical screening/management 1 2 3 4 5 N/A
f Pelvic examination / sizing 1 2 3 4 5 N/A
g Pain management techniques 1 2 3 4 5 N/A
h Vacuum aspiration technique 1 2 3 4 5 N/A
i Use of ultrasound 1 2 3 4 5 N/A
j Routine post-abortion care 1 2 3 4 5 N/A
k Opportunities to ask questions 1 2 3 4 5 N/A
l Opportunities to interact with clinic staff 1 2 3 4 5 N/A
  1. What did you find most valuable about the training?

 

  1. What did you find least valuable about the training?

 

  1. Did the abortion training rotation adequately prepare you to:
a Counsel patients about pregnancy options Yes No, need more
b Counsel patients choosing abortion Yes No, need more
c Counsel patients about contraceptive options Yes No, need more
d Obtain informed consent for abortion Yes No, need more
e Perform accurate pelvic sizing Yes No, need more
f Perform aspiration procedures under local anesthesia Yes No, need more
g Perform 1st trimester aspiration abortions with confidence Yes No, need more
h Manage common abortion complications Yes No, need more
i Integrate abortion with other health services in your regular practice Yes No, need more
  1. What are your long-term career plans?

 

  1. Where do you hope to practice after graduating?

☐ In this state

☐ In another US state (specify:                                 )

☐ Outside the US (specify:                                 )

☐ Don’t know yet

 

7. Do you plan to pursue additional abortion training during or after your residency or training program?

If “Yes,” what additional training? ______________________________________________________________

 Yes No Undecided
8. Do you anticipate providing aspiration abortions in your post-graduate practice? Yes No Undecided
9. Do you anticipate providing medication abortions in your post-graduate practice? Yes No Undecided

 

  1. Since completing the abortion training rotation, has your interest in or commitment to providing abortion services:

☐ Increased

☐  Decreased

☐  Remained the same

 

  1. Has the abortion training rotation influenced your attitudes or opinions about abortion in any positive or negative way? Please explain:

 

 

  1. What suggestions do you have for improving the training program?

 

 

  1. Other comments:

 

 

 

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TEACH Abortion Training Curriculum Copyright © 2022 by UCSF Bixby Center for Global Reproductive Health. All Rights Reserved.