Form B Evaluation form for training of AIM Team Leads

Safety Program for Perinatal Care II – Demonstration Project

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

Public reporting burden for this collection of information is estimated to average 5 minutes per response, the estimated time required to complete the survey. 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: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 5600 Fishers Lane, # 07W41A, Rockville, MD 20857.

Dear Respondent,

The Safety Program in Perinatal Care-II (SPPC-II) Demonstration Project, implemented jointly by the Johns Hopkins University and the Alliance for Innovation on Maternal Health (AIM) with funding from the Agency for Healthcare Research and Quality, aims to demonstrate the value of integrating teamwork and communication training with AIM maternal safety bundles for obstetric hemorrhage and severe hypertension in pregnancy. You are being asked to complete this brief evaluation survey because you attended one of the SPPC-II Demonstration Project training workshop.

Your responses will be kept confidential to the extent permitted by law, including AHRQ’s confidentiality statute, 42 USC 299c-3(c). That law requires that information collected for research conducted or supported by AHRQ that identifies individuals or establishments be used only for the purpose for which it was supplied unless you consent to the use of the information for another purpose.

TIER II TRAINING EVALUATION FORM

Please assess the following:	Poor	Below expectations	Satisfactory	Good	Excellent
Relevance of learning objectives
Appropriateness of teaching strategies
Teaching effectiveness of the speakers
Pace of training
Length of training
Training met overall expectations
Do you feel prepared to facilitate training and simulations of teamwork and communication tools and strategies for frontline clinical staff at your hospital?	Unprepared	Somewhat unprepared	Neither prepared nor unprepared	Somewhat prepared	Prepared