Form 0920-0995 Intensive Complete Post-Course Evaluation wordversion
National Network of Sexually Transmitted Disease Clinical Prevention Traning Centers (NNPTC)
Att 5 Intensive Complete Post Course Evaluation wordversion + cover sheet
Intensive Complete Post-Couse Evaluation
OMB: 0920-0995
National Network of Sexually Transmitted Disease Clinical Prevention Training Centers (NNPTC): Evaluation
OMB No. 0920-0995
Attachments 5 & 6
Intensive Complete Post-Course Evaluation Instrument
Word version and screenshot
TODAY’S DATE
____________________________ M M D D Y Y |
Your confidential ID number is the first two letters of your FIRST name, the first two letters of your LAST name, the MONTH of your birth, and the DAY of your birth. |
CONFIDENTIAL IDENTIFIER |
Intensive Complete POST Course Evaluation
Public reporting burden of this collection of information is estimated to average 16 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 Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0995).
S1 How satisfied were you with your overall learning experience?
-
very unsatisfied
very satisfied
S2 How satisfied were you with the quality of the content?
-
very unsatisfied
very satisfied
S3 How satisfied were you with the trainer(s)?
-
very unsatisfied
very satisfied
S4 How satisfied were you with the teaching methods?
-
very unsatisfied
very satisfied
S5 What could improve this training?
|
CE1 Do you believe this activity was influenced by commercial interests?
Yes
No
CE2 Was this presentation evidence-based?
Yes
No
CE3a Were the learning objectives met?
Yes
No
CE3b If the learning objectives were not met, please explain.
|
A1 As a result of information presented, do you intend to make changes in your practice or at your worksite
setting?
Yes
No
Not my job
I already use these practices
Other reason (please specify)__________________________________
A2 If yes, please list at least one intended change.
|
CHLAMYDIA |
LOC1bef How confident were you in your ability to describe how chlamydia infections present clinically,
BEFORE the training?
-
not at all confident
very confident
LOC1aft How confident are you AFTER the training?
-
not at all confident
very confident
LOC2bef How confident were you in your ability to describe the current CDC screening recommendations for
chlamydia, including extra-genital screening BEFORE the training?
-
not at all confident
very confident
LOC2aft How confident are you AFTER the training?
-
not at all confident
very confident
LOC3bef How confident were you in your ability to obtain or instruct patients to collect the recommended specimens from indicated sites to diagnose chlamydia BEFORE the training?
-
not at all confident
very confident
77NA
LOC3aft How confident are you AFTER the training?
-
not at all confident
very confident
NA
LOC4bef How confident were you in your ability to treat patients diagnosed with chlamydia and related
anogenital syndromes based on the most current CDC treatment recommendations BEFORE the training?
-
not at all confident
very confident
NA
LOC4aft How confident are you AFTER the training?
-
not at all confident
very confident
NA
KC1 What is the CDC recommended regimen for treating asymptomatic uncomplicated chlamydia infection of
the cervix, urethra, or rectum?
Acyclovir 1 g twice a day for 7 days
Azithromycin 1 g orally in a single dose or doxycycline 100 mg twice a day for 7 days
Azithromycin 1 g orally in a single dose plus ceftriaxone 250 mg intramuscularly in a single dose
Ciprofloxacin 500 mg orally in a single dose
KC2 What is the recommended follow-up for a non-pregnant patient after diagnosis and treatment of
chlamydia?
A test of cure at 2 weeks, and repeat test at 3 months
A test of cure at 2 weeks, and repeat test at 12 months
Repeat test in 3 months
Repeat test in 12 months
PPC1bef Approximately what % of sexually active asymptomatic female patients under age 25 did you screen
annually for chlamydia BEFORE this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
77
PPC1aft What % do you intend to screen AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPC2bef Approximately what % of pregnant patients under age 25 did you screen for chlamydia BEFORE this
training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPC2aft What % do you intend to screen AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
GONORRHEA |
LOG1bef How confident were you in your ability to describe how gonorrhea infections present clinically
BEFORE this training?
-
not at all confident
very confident
LOG1aft How confident are you AFTER the training?
-
not at all confident
very confident
LOG2bef How confident were you in your ability to describe the current CDC screening recommendations
for gonorrhea, including extra-genital screening BEFORE this training?
-
not at all confident
very confident
LOG2aft How confident are you AFTER the training?
-
not at all confident
very confident
LOG3bef How confident were you in your ability to obtain or direct patients to collect
the recommended specimens from indicated sites to diagnose gonorrhea BEFORE this training?
-
not at all confident
very confident
77NA
LOG3aft How confident are you AFTER the training?
-
not at all confident
very confident
NA
LOG4bef How confident were you in your ability to treat patients with gonorrhea according to current
CDC recommendations in light of antibiotic resistance in N. gonorrhoeae BEFORE this training?
-
not at all confident
very confident
NA
LOG4aft How confident are you AFTER the training?
-
not at all confident
very confident
NA
KG1
What
is the CDC
recommended treatment for a patient diagnosed with uncomplicated
urethral, cervical, or rectal gonorrhea?
Ceftriaxone 250 mg intramuscularly only
Azithromycin 2 g orally in a single dose only
Ceftriaxone 250 mg intramuscularly plus azithromycin 1 g orally in a single dose
Cefixime 400 mg orally plus doxycycline 100 mg orally BID for 7 days
KG2 What is the recommended follow-up for a non-pregnant patient after diagnosis and treatment of
gonorrhea?
A test of cure at 2 weeks, and repeat test at 3 months
A test of cure at 2 weeks, and repeat test at 12 months
Repeat test in 3 months
Repeat test in 12 months
PPG1bef Approximately what % of sexually active asymptomatic female patients under 25 did you screen
annually for gonorrhea BEFORE this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
77
PPG1aft What % do you intend to screen AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPG2bef Approximately what % of pregnant patients under age 25 did you screen for gonorrhea BEFORE
this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPG2aft What % do you intend to screen AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPG3bef Approximately what % of sexually active male patients who have sex with men did you screen
annually for urogenital and extragenital gonorrhea and chlamydia BEFORE this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPG3aft What % do you intend to screen AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
SYPHILIS |
LOS1bef How confident were you in your ability to identify the stages of syphilis based on their clinical
manifestations BEFORE this training?
-
not at all confident
very confident
LOS1aft How confident are you AFTER the training?
-
not at all confident
very confident
LOS2bef How confident were you in your ability to describe current CDC screening recommendations for
syphilis BEFORE this training?
-
not at all confident
very confident
LOS2aft How confident are you AFTER the training?
-
not at all confident
very confident
LOS3bef How confident were you in your ability to order and interpret the CDC recommended serologic
tests to diagnose syphilis BEFORE this training?
-
not at all confident
very confident
77NA
LOS3aft How confident are you AFTER the training?
-
not at all confident
very confident
NA
LOS4bef How confident were you in your ability to clinically manage patients diagnosed with syphilis based on
CDC treatment, follow-up, and partner management recommendations BEFORE this training?
-
not at all confident
very confident
NA
LOS4aft How confident are you AFTER the training?
-
not at all confident
very confident
NA
KS1 What is the CDC recommended regimen for treating primary and secondary syphilis in adults who are
not HIV+ or pregnant?
Acyclovir 1 g twice a day for 7 days
Azithromycin 1 g orally in a single dose
Benzathine penicillin G 2.4 million units IM in a single dose
Benzathine-procaine penicillin 2.4 million units in a single dose
PPS1bef Approximately what % of your male patients who have sex with men did you screen at least once a year
for syphilis BEFORE this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPS1aft What % do you intend to screen AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPS2bef Approximately what % of your pregnant patients did you screen for syphilis BEFORE this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPS2aft What % do you intend to screen AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPS3bef Approximately what % of your patients recently diagnosed with syphilis did you test for HIV
BEFORE this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPS3aft What % do you intend to screen AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
HUMAN PAPILLOMAVIRUS (HPV) |
LOHPV1bef How confident were you in your ability to describe the pathogenesis of genital HPV and identify
it clinically BEFORE this training?
-
not at all confident
very confident
LOHPV1aft How confident are you AFTER the training?
-
not at all confident
very confident
LOHPV2bef How confident were you in your ability to describe the national cervical cancer
screening recommendations, including HPV testing, BEFORE this training?
-
not at all confident
very confident
LOHPV2aft How confident are you AFTER the training?
-
not at all confident
very confident
LOHPV3bef How confident were you in your ability to treat genital warts BEFORE the training?
-
not at all confident
very confident
77NA
LOHPV3aft How confident are you AFTER the training?
-
not at all confident
very confident
NA
LOHPV4bef How confident were you in your ability to describe CDC/ACIP recommendations for HPV
vaccination BEFORE this training?
-
not at all confident
very confident
LOHPV4aft How confident are you AFTER the training?
-
not at all confident
very confident
PPHPV1bef With approximately what % of your non-vaccinated female patients ages 11 through 26 did you
discuss HPV vaccination during a preventive health visit BEFORE this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPHPV1aft With what % do you intend to discuss this AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPHPV2bef With approximately what % of your non-vaccinated male patients ages 11 through 21 did you discuss
HPV vaccination during a preventive health visit BEFORE this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPHPV2aft With what % do you intend to discuss this AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPHPV3bef With approximately what % of your non-vaccinated male patients age 26 or under who have sex with
men or are HIV+ did you discuss HPV vaccination during a preventive health visit BEFORE this
training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPHPV3aft With what % do you intend to discuss this AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
CONDUCTING A SEXUAL HISTORY |
LOSH1bef How confident were you in your ability to describe the major components (5 P’s) of a routine
sexual history BEFORE this training?
-
not at all confident
very confident
LOSH1aft How confident are you AFTER the training?
-
not at all confident
very confident
LOSH2bef How confident were you in your ability to demonstrate respectful, non-judgmental communication
skills to discuss sexual practices, sexual risks, and risk reduction strategies with patients
BEFORE this training?
-
not at all confident
very confident
77NA
LOSH2aft How confident are you AFTER the training?
-
not at all confident
very confident
NA
PPSH1bef For approximately what % of patients older than 15 seeing you for a preventive health visit did
you take a sexual history that asks about behaviors that could put them at risk of getting or
transmitting an STD BEFORE this training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPSH1aft What % do you intend to ask about risk behaviors AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPSH2bef For approximately what % of patients older than 15 seeing you for a preventive health visit did
you take a sexual history that asked whether they had oral, vaginal, or anal sex BEFORE this
training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
PPSH2aft What % do you intend to ask whether they had oral, vaginal, or anal sex AFTER the training?
-
0%
1-25%
26-50%
51-75%
76-90%
>91%
NA
EXPEDITED PARTNER THERAPY |
EPT As a result of the information presented do you intend to provide Expedited Partner Therapy (EPT) to
heterosexual partners of those diagnosed with gonorrhea and/or chlamydia?
Yes
No
Not applicable to my practice or job
Not allowed in my state/practice
My practice/worksite is in the planning stages to offer EPT
My practice/worksite already offers EPT
EPT was not discussed
SKILLS |
SK2bef How confident were you in your ability to list the steps in the appropriate order for
conducting an STD-oriented male genital exam BEFORE this training?
-
not at all confident
very confident
SK2aft How confident are you AFTER the training?
-
not at all confident
very confident
SK3bef How confident were you in your ability to identify the testis, epididymis and spermatic cord by
palpation BEFORE this training?
-
not at all confident
very confident
SK3aft How confident are you AFTER the training?
-
not at all confident
very confident
SK4bef How confident were you in your ability to use or direct patients to use the
correct techniques to obtain STD test specimens for male patients BEFORE this training?
-
not at all confident
very confident
SK4aft How confident are you AFTER the training?
-
not at all confident
very confident
SK5bef How confident were you in your ability to list the steps in the appropriate order for conducting an
STD-oriented female genital exam BEFORE this training?
-
not at all confident
very confident
SK5aft How confident are you AFTER the training?
-
not at all confident
very confident
SK6bef How confident were you in your ability to palpate the uterus and adnexa by bimanual exam BEFORE
this training?
-
not at all confident
very confident
SK6aft How confident are you AFTER the training?
-
not at all confident
very confident
SK7bef How confident were you in your ability to use or direct patients to use the correct techniques to
obtain STD test specimens for female patients BEFORE this training?
-
not at all confident
very confident
SK7aft How confident are you AFTER the training?
-
not at all confident
very confident
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Course Design and Delivery |
| Author | dreisbach |
| File Modified | 0000-00-00 |
| File Created | 2022-02-24 |
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