Physician Training Retreat 3-Month Follow-up

TSA Physician Training Retreat 3 Month Follow-up

Form Approved, OMB No. 0920-XXXX Exp. Date XX/XX/20XX
This survey is in reference to the Tourette Syndrome training retreat program you attended on XXX. The retreat was
hosted through a partnership with the US Centers for Disease Control and Prevention. We would like to assess the
impact of the program on your patient care and survey results will enable us to better focus our outreach efforts.
Public reporting burden of this collection of information is estimated to average 2 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D- 74, Atlanta,
Georgia 30333; ATTN: PRA (0920-XXXX).

1. Please indicate your profession.
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Physician

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Nurse Practitioner

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Social Worker

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Physician Assistant

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Ph.D.

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Counselor

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Nurse

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Psychologist

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Occupational Therapist

2. Looking back, how much knowledge have you gained from the training retreat about
diagnosis and/or management of TS?
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None

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Some

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A lot

3. Check the following practice areas in which you feel that you have made changes in
your patient care as a result of something you learned from the TS Training Retreat
Program.
Considering changes

Planning changes

Have made changes

Not yet applicable

Recognition and accurate diagnosis of TS

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n

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n

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n

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Identification of co-occurring conditions in

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n

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n

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n

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n

Treatment planning for individuals with TS

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n

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n

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n

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Education of the patient and family

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patients with TS

4. Since the TS Training Retreat Program, how many patients with tic disorders/Tourette
syndrome have you evaluated?
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0

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1-5

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6-10

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>10

TSA Physician Training Retreat 3 Month Follow-up
5. Do you think that your skills in managing patients with TS have improved as a result
of attending the program?
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Yes

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No

Comment:

6. Did the TS Training Retreat Program make you reconsider any patients for a possible
TS diagnosis?
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Yes

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No

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N/A at this time

7. As a result of the TS Training Retreat Program, do you feel that you have focused
more on evaluating co-occurring conditions in patients with TS?
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Yes

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No

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N/A at this time

8. Whether or not you have made a change, please rate the usefulness of the program to
your current practice.
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Very useful

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Useful

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Somewhat useful

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Not at all useful

9. Please describe any other changes you may have made as a result of something you
learned from the TS Training Retreat Program.
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