OMB Control Number 0920-0995
Exp. Date 06/30/2023
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 |
Public
reporting burden of this collection of information is estimated to
average 10 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).
Intensive Post-Course Evaluation
S1. How satisfied were you with your overall learning experience?
very unsatisfied |
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very satisfied |
S2. How satisfied were you with the quality of the content?
very unsatisfied |
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very satisfied |
S3. How satisfied were you with the trainer(s)?
very unsatisfied |
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very satisfied |
S4. How satisfied were you with the teaching methods?
very unsatisfied |
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very satisfied |
A1. The training is relevant to my work.
strongly disagree |
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Strongly agree |
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A2. The training will improve the way I do my work.
strongly disagree |
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Strongly agree |
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CE3. Were the learning objectives for this training met?
Yes
No
K1bef. How much did you know about the topics covered in this session BEFORE this training?
no knowledge |
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all the knowledge |
K1aft. How much do you know AFTER the training?
no knowledge |
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all the knowledge |
SK1bef. How confident were you in your ability to perform the practices taught in this session, BEFORE this training?
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SK1aft. How confident are you AFTER the training?
Not at all confident |
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Very confident |
A3. I will use what I learned in this training in my work.
strongly disagree |
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Strongly agree |
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A5. 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
Other reason (please specify) ____________________________________
A5a. If yes, please list at least one intended change.____________________________________
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As a result of the information presented do you intend to…
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Yes |
No |
I already do this |
SGCH1 |
Use the CDC STD Treatment Guidelines in your practice? |
1 |
0 |
2 |
SGCH2 |
Download the CDC STD Treatment Guidelines app? |
1 |
0 |
2 |
SGCH3 |
Use the STD Treatment Guidelines wall chart or pocket guide? |
1 |
0 |
2 |
SGCH4 |
Send a consult to the STD Clinical Consultation Network? www.stdccn.org |
1 |
0 |
2 |
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As a result of the information presented do you intend to… (Select ‘Not Applicable’ if the training did not cover the content area listed) |
Yes |
No |
I already do this |
N/A |
SGCH5 |
Increase the proportion of your sexually active asymptomatic female patients under age 25 screened annually for urogenital chlamydia and gonorrhea? |
1 |
0 |
2 |
3 |
SGCH6 |
Increase the proportion of your male patients who have sex with men screened for syphilis, gonorrhea, and chlamydia at least annually? |
1 |
0 |
2 |
3 |
SGCH7 |
Use CDC-recommended antibiotic therapy to treat uncomplicated gonorrhea? |
1 |
0 |
2 |
3 |
SGCH8 |
Recommend rescreening in 3 months following a gonorrhea, chlamydia or trichomonas diagnosis? |
1 |
0 |
2 |
3 |
S5. What could improve this training? _____________________________________________________________
S6. What would make the training more useful for your practice or job? ________________________________
S7. What additional topic(s) would you like to be covered in future trainings? ___________________________
CE1 Do you believe this training was influenced by commercial interests?
Yes
No
CE2 Was the training evidence-based?
Yes
No
The following questions ask you to rate your confidence providing STD care in six main categories. Your responses will help us understand if the training is helpful for your practice.
CHLAMYDIA |
LOC1bef How confident were you in your ability to describe how chlamydia infections present clinically,
BEFORE the training?
not at all confident |
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very confident |
LOC1aft How confident are you AFTER the training?
not at all confident |
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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 |
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very confident |
LOC2aft How confident are you AFTER the training?
not at all confident |
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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 |
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very confident |
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77 |
NA |
LOC3aft How confident are you AFTER the training?
not at all confident |
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very confident |
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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 |
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very confident |
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NA |
LOC4aft How confident are you AFTER the training?
not at all confident |
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very confident |
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NA |
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% |
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NA |
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77 |
PPC1aft What % do you intend to screen AFTER the training?
0% |
1-25% |
26-50% |
51-75% |
76-90% |
>91% |
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NA |
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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% |
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NA |
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PPC2aft What % do you intend to screen AFTER the training?
0% |
1-25% |
26-50% |
51-75% |
76-90% |
>91% |
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NA |
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GONORRHEA |
LOG1bef How confident were you in your ability to describe how gonorrhea infections present clinically
BEFORE this training?
not at all confident |
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very confident |
LOG1aft How confident are you AFTER the training?
not at all confident |
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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 |
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very confident |
LOG2aft How confident are you AFTER the training?
not at all confident |
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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 |
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very confident |
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77 |
NA |
LOG3aft How confident are you AFTER the training?
not at all confident |
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very confident |
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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 |
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very confident |
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NA |
LOG4aft How confident are you AFTER the training?
not at all confident |
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very confident |
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NA |
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% |
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NA |
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77 |
PPG1aft What % do you intend to screen AFTER the training?
0% |
1-25% |
26-50% |
51-75% |
76-90% |
>91% |
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NA |
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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% |
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NA |
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PPG2aft What % do you intend to screen AFTER the training?
0% |
1-25% |
26-50% |
51-75% |
76-90% |
>91% |
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NA |
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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% |
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NA |
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PPG3aft What % do you intend to screen AFTER the training?
0% |
1-25% |
26-50% |
51-75% |
76-90% |
>91% |
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NA |
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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 |
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very confident |
LOS1aft How confident are you AFTER the training?
not at all confident |
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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 |
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very confident |
LOS2aft How confident are you AFTER the training?
not at all confident |
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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 |
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very confident |
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77 |
NA |
LOS3aft How confident are you AFTER the training?
not at all confident |
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very confident |
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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 |
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very confident |
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NA |
LOS4aft How confident are you AFTER the training?
not at all confident |
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very confident |
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NA |
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% |
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NA |
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PPS1aft What % do you intend to screen AFTER the training?
0% |
1-25% |
26-50% |
51-75% |
76-90% |
>91% |
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NA |
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PPS2bef Approximately what % of your pregnant patients did you screen for syphilis BEFORE this training?
PPS2aft What % do you intend to screen AFTER the training?
0% |
1-25% |
26-50% |
51-75% |
76-90% |
>91% |
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NA |
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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% |
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NA |
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PPS3aft What % do you intend to screen AFTER the training?
0% |
1-25% |
26-50% |
51-75% |
76-90% |
>91% |
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NA |
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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 |
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very confident |
LOHPV1aft How confident are you AFTER the training?
not at all confident |
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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 |
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very confident |
LOHPV2aft How confident are you AFTER the training?
not at all confident |
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very confident |
LOHPV3bef How confident were you in your ability to treat genital warts BEFORE the training?
not at all confident |
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very confident |
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77 |
NA |
LOHPV3aft How confident are you AFTER the training?
not at all confident |
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very confident |
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NA |
LOHPV4bef How confident were you in your ability to describe CDC/ACIP recommendations for HPV
vaccination BEFORE this training?
not at all confident |
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very confident |
LOHPV4aft How confident are you AFTER the training?
not at all confident |
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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% |
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NA |
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PPHPV1aft With what % do you intend to discuss this AFTER the training?
0% |
1-25% |
26-50% |
51-75% |
76-90% |
>91% |
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NA |
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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% |
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NA |
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PPHPV2aft With what % do you intend to discuss this AFTER the training?
0% |
1-25% |
26-50% |
51-75% |
76-90% |
>91% |
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NA |
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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% |
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NA |
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PPHPV3aft With what % do you intend to discuss this AFTER the training?
0% |
1-25% |
26-50% |
51-75% |
76-90% |
>91% |
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NA |
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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 |
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very confident |
LOSH1aft How confident are you AFTER the training?
not at all confident |
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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 |
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very confident |
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77 |
NA |
LOSH2aft How confident are you AFTER the training?
not at all confident |
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very confident |
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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% |
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NA |
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PPSH1aft What % do you intend to ask about risk behaviors AFTER the training?
0% |
1-25% |
26-50% |
51-75% |
76-90% |
>91% |
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NA |
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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% |
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NA |
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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% |
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NA |
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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 |
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very confident |
SK2aft How confident are you AFTER the training?
not at all confident |
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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 |
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very confident |
SK3aft How confident are you AFTER the training?
not at all confident |
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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 |
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very confident |
SK4aft How confident are you AFTER the training?
not at all confident |
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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 |
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very confident |
SK5aft How confident are you AFTER the training?
not at all confident |
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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 |
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very confident |
SK6aft How confident are you AFTER the training?
not at all confident |
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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 |
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very confident |
SK7aft How confident are you AFTER the training?
not at all confident |
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very confident |
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Ariyo, Oluwatosin (CDC/DDID/NCHHSTP/DSTDP) |
File Modified | 0000-00-00 |
File Created | 2022-02-24 |