Form 1 questionnaire

PHTC Participant Survey

Section 1: Demographics and Background of the course

Which of the following best describes your job?

1. Aaaaaa

2. Bbbbbb

3. Cccccc

4. Ddddd

5. Eeeeee

6. ffffffff

What is your gender?

1. Male

2. Female

What is the highest level of education that you have completed?

1. Some college

2. Associate’s degree

3. Nursing degree

4. 4-year college degree

5. Some graduate college

6. Master’s degree

7. PHD

8. Other

What institution offered this course?

How did you hear about the course? (Select all that apply.)

	Yes	No
I received an email about the course.		
I read about the course on a website.		
My manager told me about the course.		
My co-worker told me about the course.		
HRSA TRAIN search		
I heard about the course some other way.		
Please specify:

What are the top two reasons you took the course? (Select two.)

• I was required to take the course.

• My manager recommended that I take the course (but it was not required).

• I wanted to improve specific knowledge or skills.

• I was generally interested in the course content.

• Some other factor motivated me to participate in the course. Please specify: __________.

Before the course began, how useful did you think it would be for your job?

• Very useful

• Somewhat useful

• Not at all useful

• I didn’t know how useful the course would be

How was this course administered?

• Webinar

• Teleconference

• In-person

• Other

How satisfied were you with the course administration mode (e.g., in-person, webinar, teleconference)?

• Very satisfied

• Somewhat satisfied

• Neither satisfied nor dissatisfied

• Somewhat dissatisfied

• Very dissatisfied

Section 2: General Satisfaction

How knowledgeable was the instruction about the topic of the course?

• Very knowledgeable

• Somewhat knowledgeable

• Not at all knowledgeable

How prepared was the instructor?

• Very prepared

• Somewhat prepared

• Not at all prepared

How understandable was the message the was trying to convey?

• Very understandable

• Somewhat understandable

• Not at all understandable

How engaging was the instructor during the course?

• Very engaging

• Somewhat engaging

• Not at all engaging

Do you feel you were given ample opportunity to practice the skills you learned during the course?

• Yes

• No

Please indicate how much you agree with each of the following statements about the your experience in this training course.

	Strongly Agree	Agree	Neither Agree nor Disagree	Disagree	Strongly Disagree
I was satisfied with the course overall.	O	O	O	O	O
The topics discussed were important to me.	O	O	O	O	O
This course enhanced my knowledge of the subject matter.	O	O	O	O	O
This course was applicable to what I might be expected to do in my job.	O	O	O	O	O
The course provided content that it relevant to my daily job.	O	O	O	O	O
I would recommend this course to others.	O	O	O	O	O
This course met my individual needs.	O	O	O	O	O
I was provided the necessary materials to complete the course.	O	O	O	O	O
The course presentation provided ample interaction between instructor and students.	O	O	O	O	O
The materials used in the course were useful.	O	O	O	O	O
I felt comfortable asking questions during the course.	O	O	O	O	O
My questions were answered adequately during the course.	O	O	O	O	O
Overall the course met my expectations based on what I understood the objectives of the course were before the course began	O	O	O	O	O

Do you plan to/have you already recommended this course to a peer or colleague?

Yes, definitely

Maybe

No

Overall, how satisfied were you with this course?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

Section 3: Knowledge Acquisition

To be developed by the instructors of the courses.

3-5 multiple choice questions.

Format:

1. Question question question question?

   1. Answer choice

   2. Answer choice

   3. Answer choice

   4. Answer choice

Section 4: Integration and Application

How often will you be able to use what you’ve learned in this course in your current job?

• Daily

• Once or twice per week

• Once or twice per month

• Once or twice per year

• Never

There are specific skills or knowledge that you acquired in the course that you will be able to (have been able to) use in my job. How strongly do you agree with this statement?

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

How has your work behavior changed due to the skills and/or knowledge your received in this course? Check all that apply

• answer

• answer

• answer

• answer

• answer

How will you apply what you learned in the course to your current job?

_______________________________________________________________________

How has this course helped you perform the roles and responsibilities of your current job?

_______________________________________________________________________