TRAINING PROGRAM EVALUATION FORM
For completion by training participants.
Be sure to complete any additional evaluation required by your residency or training program.
Training Program: ________________________
Program Year: __________________________
- Please evaluate the following aspects of your training experience by circling the appropriate response:
|Poor||Satisfactory||Good||Excellent||Outstanding||Did not experience|
|d||Abortion counseling experience||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|
- What did you find most valuable about the training?
- What did you find least valuable about the training?
- 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|
- What are your long-term career plans?
- 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? ______________________________________________________________
|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|
- Since completing the abortion training rotation, has your interest in or commitment to providing abortion services:
☐ Remained the same
- Has the abortion training rotation influenced your attitudes or opinions about abortion in any positive or negative way? Please explain:
- What suggestions do you have for improving the training program?
- Other comments: