Educational Ambassadors Program
Training report – Host Center
Please fill out the report below related to your visit to a Host center in the context of the ISN GO Educational Ambassadors Program. Thank you for also sending us the final program and any pictures of your EAP experience. Completed and duly signed forms may be sent by post, fax or e-mail, as it is most suitable to you. Scanned copies are acceptable.
For any question, do not hesitate to contact Giorgia Manuzi. This report must be submitted within 30 days following the end of the training at the host center.
ISN Global Operations Center
Ms. Giorgia Manuzi
Global Outreach Programs Administrator
Rue des Fabriques 1B, 1000 - Brussels, Belgium
Phone: +32 2 808 04 20 Fax: +32 2 808 44 54
E-mail:
Website:
MAIN CONTACT DETAILS
Last Name:
First Name:
ISN Membership ID:
E-mail:
Institution Name:
Address 1:
Address 2:
Post Code:
City:
Country:
TRAINING INFORMATION
  1. Main Topic
Dialysis
Transplantation
Epidemiology
Clinical Nephrology
Acute Kidney Injury
Interventional Nephrology
Renal Pathology
Critical Care Nephrology
Education Teaching - Please specify area:
Other - Please specify area:
  1. Duration

Start date: / (DD/MM/YYYY)
End date: / (DD/MM/YYYY)
  1. Details about Ambassador:

Last Name:
First Name:
Nationality:
  1. Are you satisfied with the training? What would be your overall rate?
Excellent / Very Good / Good / Average / Poor
  1. Was the duration of the training long enough to cover the whole program?
Yes / No
If no, please explain:
  1. Please provide a summary of the activities held or enclose the final program with this report:

  1. Were the objectives of the training were fully achieved?
Yes, absolutely / Yes, but only partly / No
If the main objectives of the training were not achieved or only partly, please justify:
  1. Please list the achieved objectives:

  1. Roughly, how would you estimate the balance between theory and practice?

Theory: % Practice: %
  1. Was there enough time devoted to discussion and interaction?
Yes / No
If no, please explain:
  1. What are the 3 most valuable things you have learnt during the training?
1)
2)
3)
  1. What were the strengths of the training?

  1. Is there anything you were disappointed about? Did you encounter any difficulty during the training?

Comments:
ISN EDUCATIONAL AMBASSADOR
  1. How did you get to know the ISN Educational Ambassador that visited you?
ISN Headquarters / SRC Contact / Personal Contact / Other:
  1. How would you rate the contacts and interaction with the Ambassador before and during the training?
Excellent / Very Good / Good / Average / Poor
  1. How would you rate his/her teaching methods?
Excellent / Very Good / Good / Average / Poor
Comments:
AUDIENCE
  1. Number of participants:

  1. Indicate the categories and numbers of renal professionals that have benefitted from the training:
Nephrologists
Pathologists
Technicians
Administrators
Trainees/ Residents
Students
Renal Pathologist
Other - Please specify:
GENERAL COMMENTS ON THE EDUCATIONAL AMBASSADORS PROGRAM
  1. Would you recommend other institutions to get involved in the program? If so, why? Max 100 words.

  1. How do you think the ISN Educational Ambassadors Program will help local medical professionals in the future? Max 100 words.

  1. What was the most rewarding experience of the visit in the context of the EAP? Max 150 words.

INTERACTION WITH THE ISN HEADQUARTERS
  1. How would you rate the interaction with the ISN Headquarters?
Excellent / Very Good / Good / Average / Poor
  1. Was the application procedure easy to follow?
Yes / No / Intermediate
Do you agree that the information provided in the above sections (except the contact details provided) is used for marketing and communication purposes (ISN News, ISN Gateway and Social Network)?
Yes / No
Signature Date

1