DO NOT WRITE YOUR NAME ON THIS SURVEY

 

PLEASE PRINT LEGIBLY

 

Human Trafficking in the Emergency Department: The Evaluation

 

  1. Date ____________
  2. Institution (circle one):             Rhode Island The Miriam
  3. provider type (check one):     p attending    p EM resident                           

p physician assistant              p nurse practitioner  p registered nurse    

p  “moonlighter”       p  “traveling nurse” p other___________________

  1. years in this role (check one):             p <1                   p 1-3                 p 4-5                p 6-10                                                                           p >10
  2. years working in the emergency dept (any ED; check one): 

p <1          p 1-3                 p 4-5                p 6-10                              p >10

  1. Before this session, did you know what human trafficking was? (circle one)

p Yes                        p No

  1. After this session, can you comfortably define human trafficking? (circle one)

Very comfortable……..Comfortable….…..Hesitant…..…....Not Comfortable

1                                          2                                          3                                          4

  1. After this session, how confident are you in your ability to identify a human trafficking victim in the E.D.? (circle one)

Very confident………….Confident…………..Hesitant…………....Not Confident

1                                          2                                          3                                          4

  1. After this session, how confident are you in your ability to correctly treat a human trafficking victim in the E.D.? (circle one)

Very confident……..…..Confident……..……..Hesitant…….……..Not Confident

1                                          2                                          3                                          4

  1.  I found this session (check all that apply):

p useful                           p purely educational               p not at all educational          

p well organized         p adequately organized          p poorly organized

p thorough                    p tedious                                       p incomplete               

p well timed                  p adequately timed                   p poorly timed            

p motivating                 p interesting                                 p boring          

              

PLEASE INCLUDE COMMENTS ON REVERSE

 

 

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

 

 

THANK YOU FOR YOUR TIME