Pre Course Survey

Pre Course Survey

Section I: Background/Experience

1. Current Position: (Check one)

___Attending Physician ___ Maternal Fetal Medicine Specialist ____Nurse Midwife

___Nurse ___ Resident

___ GMT1 ___ GMT4

___ GMT2 ___ GMT5

___ GMT3 ___ GMT6

___ GMT 7

2. Experience in current position: ____ years 3. _____Age

4. Ethnicity: _____Caucasian ______Asian_____African American____Hispanic____Other

5. Gender______

6. Prior experience with human simulation? (Check one)

____ No ____ Yes, a little ____ Yes, extensive

7. For each item below, place a check in the box that best describes HOW OFTEN YOU HAVE PARTICIPATED in the care of patients with the following obstetric emergencies.

My experience with:

None / A little
(e.g. a couple of times) / Moderate
(e.g. several times) / Extensive
(e.g. numerous times)
1. Shoulder dystocia
2. Intrapartum Hemorrhage
3. Post partum Hemorrhage
4. Placental Abruption
5. Amniotic Embolism
6. Need for neonatal resuscitation with no pediatric support staff available
7. Cardiac Arrest
8. Inadequate anesthesia

Section II. Self Assessment and Attitudes

1. For each item below, please indicate below YOUR CURRENT LEVEL OF COMPETENCE in the care/management of patients with the following obstetric emergencies. Place a check in the box that best describes your current level of competence.

My current Competence in the care/management of:

Need to improve I am competent I am expert

1 / 2 / 3 / 4 / 5
1. Shoulder dystocia
2. Intrapartum Hemorrhage
3. Post partum Hemorrhage
4. Placental Abruption
5. Amniotic Embolism
6. Neonatal resuscitation with no
no pediatric support staff available
7. Cardiac Arrest
8. Inadequate anesthesia
9. Prolonged Bradycardia
10. Maternal Anaphylaxis

2. Please indicate YOUR CURRENT LEVEL OF CONFIDENCE in your skill to successfully cope with

each emergency listed below by checking the box that best describes your current level of confidence.

My current Confidence in the care/management of:

Not confident Moderately Confident Very confident

1 / 2 / 3 / 4 / 5
1. Shoulder dystocia
2. Intrapartum Hemorrhage
3. Post partum Hemorrhage
4. Placental Abruption
5. Amniotic Embolism
6. Neonatal resuscitation with no
pediatric support staff available
7. Cardiac Arrest
8. Inadequate anesthesia
9. Prolonged Bradycardia
10. Maternal Anaphylaxis

3. Please indicate YOU’RE attitudes toward the use of human simulation technology by checking the box that best describes your agreement with each statement.

Strongly disagree / Somewhat disagree / Neutral / Somewhat agree / Strongly agree
1. Simulation training may not be a valuable training tool as it does not capture the complexity of reality.
2. Simulation is effective because it elicits a realistic response.
3. Simulation training does not provide a safe place to learn new skills.
4. Simulation training is a good way to practice without danger.
5. Simulation training is ineffective because of the artificial environment.
6. Simulation training enhances the ability of participants to learn new skills.

4. Please indicate YOUR attitudes toward training by checking the box that best describes your agreement/disagreement with each statement.

Strongly disagree / Somewhat disagree / Neutral / Somewhat agree / Strongly agree
1. I worry about how others will view my work performance.
2. If I know someone is judging me, I get so focused on how I am doing that I have difficulty concentrating on the job.
3. I am unconcerned even if I know that other people are forming an unfavorable impression of me.
4. I am unable to concentrate fully in stressful situations.
5. I am able to remain calm and relaxed in stressful situations.
6. I am afraid of other people noticing my shortcomings

5. Everyone works in a team or group at some time in their career. The following statements pertain to participation and relationships in, and thoughts about the various work groups or teams to which you currently belong, or have belonged in the past. Respond to each statement below, as honestly as possible, with respect to YOUR feelings about working in those particular groups. Check the box that best describes your agreement/disagreement with each statement.

Strongly disagree / Somewhat disagree / Neutral / Somewhat agree / Strongly agree
1. I preferred to work in those groups rather than working alone.
2. Group goals were more important to me than my personal goals.
3. I cared more about the goals of those groups than my own goals.
4. I felt comfortable counting on team members to do their part.
5. I cared about the well being of those teams.
6. I felt comfortable trusting team members to handle their tasks.
7. The success of the group was important to me.
8. I was not bothered by the need to rely on group members.
9. I was concerned about the needs of those groups.
10. I wanted to work with those groups as opposed to working alone.
11. I emphasized the goals of the teams more than my own individual goals.
12. Working in those teams was better than working alone.
13. I used my authority to make a decision in my favor.
14. I proposed middle ground for breaking deadlocks.
15. I accommodate the wishes of my team.
16. I tried to keep my disagreement with other group members to my self in order to avoid hard feelings.
17. I used my expertise to make a decision in my favor.
18. I collaborated with my teammates to come up with decisions acceptable to us.
19. I use my influence to get my ideas accepted.
20. I tried to work with my group members to find satisfactory solutions.
21. I tried to avoid unpleasant exchanges with other group members.

Section III: Attitudes toward the Rapid Response Team (Code Stork)

1. Please indicate below YOUR current attitudes toward the Rapid Response Team in particular by checking the box that best describes your agreement with each statement.

Strongly disagree / Somewhat disagree / Neutral / Somewhat agree / Strongly agree
1. The rapid response team is not effective in preventing crisis from becoming adverse events.
2. The team members of the rapid response team are responsible for determining the best way to resolve the crisis.
3. The rapid response team does not work well together.
4. The team members of the rapid response team work well together to resolve a crisis.
5. The rapid response team is empowered to intervene in a crisis to improve patient outcomes.
6. The rapid response team does not have the authority to resolve a crisis.

2. Please indicate below YOUR current level of comfort in assuming each of the following roles (with their associated tasks) in the Rapid Response Team.

Not Somewhat Very

Comfortable Comfortable Comfortable

1 / 2 / 3 / 4 / 5
Treatment leader
Procedure provider
Documenter
Bedside assistant
Runner

3. The following items pertain to training crisis team behaviors in general. Please indicate YOUR attitudes toward crisis team training and teamwork by placing a check in the box that best describes your agreement with the statement.

Strongly disagree / Somewhat disagree / Neutral / Somewhat agree / Strongly agree
1. Decision-making skills can improve through training.
2. Before the procedure, it is important for all team members to be familiar with the tasks and responsibilities of the other members of the team.
3. My ability to detect adverse situations has a direct relationship to the quality of decisions I make.
4. Debriefing skills can improve through training.
5. Good communication and coordination are as important as technical proficiency.
6. With trained and experienced staff members, good decisions are almost automatic in the planning and executing of operational requirements.
7. Team formation and decision-making skills are as important as the team’s technical skills.
8. In response to unplanned events, plans should be verbalized to ensure that the information is understood and acknowledged by all team members.
9. Recognizing adverse events is one of the most important keys to overall patient safety.
10. A debriefing and critique of procedures and decisions after each event is an important part of developing and maintaining effective team coordination.
11. My performance is not adversely affected by working with an inexperienced or less capable team member.
12. The staff members in the department need to be trained to “speak up” when they see something that is not right.
13. When making decisions, I gather as much information as time allows before making/executing my decision.
14. If I perceive a problem with the event, I speak up, regardless of who might be affected.
15. Verbalizing plans for procedures and ensuring that information is understood and acknowledged by all team members is critical when there is an unplanned or unbriefed shift in procedure or contingency.

Post Course Survey

Section I. Self Assessment and Attitudes

1. For each item below, please indicate below YOUR CURRENT LEVEL OF COMPETENCE in the care/management of patients with the following obstetric emergencies. Place a check in the box that best describes your current level of competence.

My current Competence in the care/management of:

Need to improve I am competent I am expert

2. Please indicate YOUR CURRENT LEVEL OF CONFIDENCE in your skill to successfully cope with

each emergency listed below by checking the box that best describes your current level of confidence.

My current Confidence in the care/management of:

Not confident Moderately Confident Very confident

1 / 2 / 3 / 4 / 5
1. Shoulder dystocia
2. Intrapartum Hemorrhage
3. Post partum Hemorrhage
4. Placental Abruption
5. Amniotic Embolism
6. Neonatal resuscitation with no
pediatric support staff available
7. Cardiac Arrest
1 / 2 / 3 / 4 / 5
8. Inadequate anesthesia
9. Prolonged Bradycardia
10. Maternal Anaphylaxis

3. Please indicate YOUR attitudes toward the use of human simulation technology by checking the box that best describes your agreement with each statement.

Strongly disagree / Somewhat disagree / Neutral / Somewhat agree / Strongly agree
1. Simulation training may not be a valuable training tool as it does not capture the complexity of reality.
2. Simulation was effective because it elicited a realistic response.
3. Simulation training does not provide a safe place to learn new skills.
4. Simulation training is a good way to practice without danger.
5. Simulation training is ineffective because of the artificial environment.
6. Simulation training enhances the ability of participants to learn new skills.

Section II: Attitudes toward the Rapid Response Team (Code Stork)

1. Please indicate below YOUR current attitudes toward the Rapid Response Team in particular by checking the box that best describes your agreement with each statement.

2. Please indicate below YOUR current level of comfort in assuming each of the following roles (with their associated tasks) in the Rapid Response Team.

Not Somewhat Very

Comfortable Comfortable Comfortable

1 / 2 / 3 / 4 / 5
Treatment leader
Procedure provider
Documenter
Bedside assistant
Runner

3. The following items pertain to training crisis team behaviors in general. Please indicate YOUR attitudes toward crisis team training and teamwork by placing a check in the box that best describes your agreement with the statement.

Knowledge Survey