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  ÒmoonlighterÓ       p  Òtraveling nurseÓ  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 comfortableÉÉ..ComfortableÉ.É..HesitantÉ..É....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 confidentÉÉÉÉ.ConfidentÉÉÉÉ..HesitantÉÉÉÉ....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 confidentÉÉ..É..ConfidentÉÉ..ÉÉ..HesitantÉÉ.ÉÉ..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

 

 

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THANK YOU FOR YOUR TIME