Thank you for taking the time to complete this survey of Human Simulation in Emergency Medicine training. There are 12 questions to be answered. The survey should take less than 5 minutes. Be sure to click the Submit button at the bottom of the form when finished.
 
Program Name:****
Department:**
Division (if applicable):**
Zip Code:****

**This data will only be used for internal accounting, data will only be reported in aggregate, no program specific information will be included and all data will be analyzed using a blinded technique.**
** Required Fields
1.) Which of these pieces of simulation equipment does your INSTITUTION have?
      (Choose all that apply)
Mannequin based high-fidelity simulator Ultrasound Simulator
Screen based computer case simulations ACLS Type mannequins
 Other: Don't Know

 

2.) Which of these pieces of simulation equipment are actually used by your FELLOWS?
     (Choose all that apply)
Mannequin based high-fidelity simulator Ultrasound Simulator
Screen based computer case simulations ACLS Type mannequins
 Other: Don't Know

 

3.) If your institution has a Mannequin Based High-Fidelity (MBHF) simulator, which department is primarily responsible for its management/supervision? (Choose One)
Anesthesia Hospital
Emergency Medicine Medical School
Pediatrics  Other:
Don't Know  

 

4.) Does your department/fellow(s) have access to a mannequin based high-fidelity simulator?
 

Yes       No       Don't Know

  

If " Yes", what is the name/manufacturer of this equipment?

IF "NO", YOU MAY SKIP THE REMAINDER OF THE SURVEY.

 

5.) Who is being taught using the MBHF simulator?
     (Choose all that apply)
EM Residents Pediatric Residents
EM Faculty Pediatric Faculty
Medical Students Pediatric EM Fellows
Nurses Paramedics
 Other (specify):  

 

6.) How often are your fellows using  the MBHF simulator for educational or assessment purposes?   (Choose One)
Not Using Daily
Yearly Weekly
Monthly Don't Know
 Other:  

 

7.) How would you describe your curriculum for human simulation in pediatric emergency medicine?
     (Choose One)
No Curriculum Developed
Initial Development (Case development, becoming familiar with equipment)
Primarily Educational (Use to teach, no formal evaluation tools used)
Formative Evaluations (Use to evaluate and critique, not for promotion/advancement)
Competence Evaluations (Use performance as criteria to promote/advance)

 

8.) How many faculty are involved with designing cases/evaluation tools for the MBHF simulator?
Number of EM Faculty Number of Pediatric Faculty
Number of Pediatric EM Faculty Don't Know

 

9.) How many faculty are involved in educational research on human simulation?
 
Number of EM Faculty Number of Pediatric Faculty
Number of Pediatric EM Faculty Don't Know

 

10.) What recognition does your faculty receive for participation in teaching/assessment with the high-fidelity human simulator? (Choose all that apply)
Release Time Teaching recognition for Tenure/Promotion
Monetary Compensation  Other recognition 
 

 

11.) What barriers to using human simulation exist at your institution?
       (Choose all that apply)
Faculty time Lack of faculty training
Cost Lack of access to equipment
 Other:  

 

 12.) Please enter any additional comments:
 


Before submitting your survey, please be sure you have entered your "Program Name" and "Zip Code" at the top of the evaluation and then type "yes" in the field below:
 

                   type "yes"

  


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