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Assessment Form

* The information you provide helps us to serve you more effectively and will not be shared with any outside party.

Program/Activity
Date of Event
Trainee Level/Year
Name (optional)
The Clinical Skills Education and Assessment Center would appreciate your completing this assessment form to help in future planning and to better ensure that we are fulfilling our users’ needs. Please use the following scale, select the appropriate rating.:
The Clinical Skills Education and Assessment Center would appreciate your completing this assessment form to help in future planning and to better ensure that we are fulfilling our users’ needs. Please use the following scale, select the appropriate rating.:
Strongly DisagreeNeutralStrongly Agree
12345N/A
During my event/activity, I used the following (mark all that apply)
If applicable, please comment on the Standardized Patients.
If applicable, please comment on the use of simulators.
If there are additional simulators and/or AV equipment that you wish were available in the Center, please list them below.
Please list strengths of the Center.
Please list ways the Center could better fulfill your needs.
Please comment on any items above or make any other general comments.
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