Three surveys (or instruments), the pre-assessment, post-assessment and follow-assessment.

Memorandum

To:

Sherette Fun
OS Report Clearance Officer
Office of the Chief Information Officer
OS Report Clearance Officer
Dept. of Health and Human Services

From:

Cheryl Thompson, MSPH
Public Health Advisor/Regional Women’s Health Liaison
Contracting Officer’s Representative
Office on Women’s Health U.S. Department of Health and Human Services

Date:

February 8, 2016

RE:

Item Modification for Survey Question 2 in the Background Section
OMB Control Number: 0990-422
Expiration Date: 5/31/2018

CC:

Deborah R. Brome. PhD
Project Manager, Education and Training of Healthcare Providers as a
Coordinated Public Health Response to Violence Against Women
GEARS, Inc. (Contractor)

I am writing to request a modification of one survey item-Question 2 found in the Background
Section of our approved OMB instruments. This question asks respondents to identify their
primary field of practice. This question is found in three surveys (or instruments), the preassessment, post-assessment and follow-assessment.
The question currently reads as follows:
2. What is your primary field of practice?
 Emergency Medicine/ Urgent Care
 Family Practice
 Internal Medicine
 Obstetrics-Gynecology
 Orthopedics
 Pediatrics
 Psychiatry
 Surgery
 Other: _______________

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We are requesting permission to modify this question by listing six additional fields of practice.
There are several professional associations participating in this data collection for which their
field of practice is not currently listed. This additional information allows for more specificity in
reporting our findings and therefore a more complete analysis of eLearning outcomes according
to fields of practice. This type of information would add to our knowledge on how to improve
the education of healthcare providers across these practice areas.
The modified question would read as follows:
2.

What is your primary field of practice?
 Emergency Medicine/ Urgent Care
 Family Practice
 Internal Medicine
 Obstetrics-Gynecology
 Orthopedics
 Pediatrics
 Adolescent Health









Psychiatry
Surgery
Behavioral Health
Nurse Practitioner
Nurse Midwifery
Physician’s Assistant
Social Work
 Other: _______________

The underlined specialty areas are those that we would like to add.
We are scheduled to launch the pilot and evaluation study on March 1, 2016. We would
greatly appreciate your assistance with an expeditious review and approval process required for
this change. Please let me know if you require additional information and thank you for your
assistance with this matter.

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