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Medical Learners/Academic Program Needs Assessment Survey

* Indicates required information

1.
Program/Service commenting on:
2.
Level of Evaluator:
Instruction SECTION 1: Non Inpatient Areas at Hamilton Health Sciences (ie. Clinics, OR, Lab, ER)(if this section does not apply to you, please move onto the next section: Inpatient areas).

The following questions are in relation to the education of medical learners:
3.
Please indicate the location primarily utilized by medical learners in your program:
Instruction INSTRUCTION: Please rate the following resources regarding the education of medical learners in relation to the areas listed below:
4. - 5
  very poor = 1 2 3 4 5 = very good  None 
a. Space for patient care:
b. Space for teaching:
6.
c. Space for team meetings (ie confidential discussions/handover):
              
7.
d. Space for patient contact (ie interview/assessment space):
              
8. - 11
  very poor = 1 2 3 4 5 = very good  None 
e. Availability of computers:
f. Health records retrieval:
g. Personal work space/office:
h. Cleanliness:
12.
Please use this space below to provide additional comments and details related to the above areas:
Instruction SECTION 2: Inpatient Areas at Hamilton Health Sciences
13.
Please indicate the location of inpatient areas utilized by medical learners in your program:
Instruction INSTRUCTION: Please rate the following resources regarding the education of medical learners in relation to the areas you’ve listed above:
14. - 15
  very poor = 1 2 3 4 5 = very good  None 
a. Space for patient care:
b. Space for teaching:
16.
c. Space for team meetings (ie confidential discussions/handover):
              
17. - 20
  very poor = 1 2 3 4 5 = very good  None 
d. Availability of computers:
e. Health records retrieval:
f. Personal work space/area:
g. Cleanliness:
21.
Does your service have access to a sufficient number of on call rooms for trainees?
           
22.
If no, list the number of additional rooms required:
Instruction INSTRUCTION: Please rate the following in relation to the call rooms:
23. - 26
  very poor = 1 2 3 4 5 = very good  None 
a. Location
b. Cleanliness
c. Maintenance
d. Bed
27.
e. Additional comments or details:
28.
Please use this space to provide additional comments and details on inpatient areas:
Instruction SECTION 3: General Areas
29.
Do the medical learners within your program currently have a secure place to store their belongings during their shift coverage?
           
30.
If yes, please indicate where:
Instruction INSTRUCTION: Using a scale of 1 (very poor) to 5 (very good) please rate the following in relation to the education of medical learners:
31.
a. Availability of meeting rooms (ie Rounds, Conferences):
              
32.
b. Paging system (functionality):
              
33.
  very poor = 1 2 3 4 5 = very good  None 
c. Food/Beverage availability:
34.
Please use this space to provide additional comments and details on general areas:
35.
8. Can we contact you for further information?
           
36.
If yes, please provide your name, email and extension:

 
Hamilton Health Sciences • Hamilton, Ontario • 905.521.2100

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