IN SITU Simulation

for CME Accredited Program only

Date of Session



What is your role?

Did the program meet the stated learning objectives?

Did you perceive any bias, whether industry or other, in any part of the program?

Was the simulation space suitable and did the simulation equipment function appropriately?

Simulation Experience

Strongly agreeAgreeNeutralDisagreeStrongly disagreeN/A
The session was clinically applicable to my training or practice
The session enhanced my teamwork or communication skills
This experience will impact the quality and safety of patient care
The facilitators created an engaging and safe environment for open and honest dialogue

Reflecting on the program content, I am motivated to change my practice in the following ways:

Can you identify any barriers to incorporating what you learned today into your practice?

Please comment on the strengths and weaknesses of the session, and share any suggestions for program improvement:

PHYSICIANS: For CFPC MainPro+ hour collection please provide name and preferred email to have your total 2023 attendance hours sent in December.

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