Research Module Evaluation Survey

Thanks for your participation in this FM Pivot module and for completing this survey. We are greatly interested in your feedback, as we hope to incorporate it in the development of future modules.

1. How many years have you been in practice?

Less than 5 years

11-15 years

16-26 years

Greater than 25 years

2. What region is your practice/institution based in?

Asia

Africa

Canada

Europe

Oceania

North America (excluding Canada)

South America/Carribean

3. How would you describe your community of practice?

Rural

Urban

Mixed

4. How would you describe your primary type of work?

Primarily clinically based (ie patient care and clinical teaching)

Primarily institution based (ie classroom teaching/research)

Mix of both clinical and institution based

5. Do you have a leadership or administrative role that takes up more than 25% of your time?

Yes

6. Please indicate your level of agreement with the following statements

	Strongly Agree	Agree	Neither Agree nor Disagree	Disagree	Strongly Disagree
The learning objectives for this module were clear.	The learning objectives for this module were clear. : 1	The learning objectives for this module were clear. : 2	The learning objectives for this module were clear. : 3	The learning objectives for this module were clear. : 4	The learning objectives for this module were clear. : 5
The learning objectives were met.	The learning objectives were met. : 1	The learning objectives were met. : 2	The learning objectives were met. : 3	The learning objectives were met. : 4	The learning objectives were met. : 5
I was easily able to register for and access this module.	I was easily able to register for and access this module. : 1	I was easily able to register for and access this module. : 2	I was easily able to register for and access this module. : 3	I was easily able to register for and access this module. : 4	I was easily able to register for and access this module. : 5
The module contents were easy to navigate.	The module contents were easy to navigate. : 1	The module contents were easy to navigate. : 2	The module contents were easy to navigate. : 3	The module contents were easy to navigate. : 4	The module contents were easy to navigate. : 5
The content was relevant to my clinical practice/teaching.	The content was relevant to my clinical practice/teaching. : 1	The content was relevant to my clinical practice/teaching. : 2	The content was relevant to my clinical practice/teaching. : 3	The content was relevant to my clinical practice/teaching. : 4	The content was relevant to my clinical practice/teaching. : 5
I feel confident in my ability to apply the content in my practice/teaching.	I feel confident in my ability to apply the content in my practice/teaching. : 1	I feel confident in my ability to apply the content in my practice/teaching. : 2	I feel confident in my ability to apply the content in my practice/teaching. : 3	I feel confident in my ability to apply the content in my practice/teaching. : 4	I feel confident in my ability to apply the content in my practice/teaching. : 5
The resource materials were useful.	The resource materials were useful. : 1	The resource materials were useful. : 2	The resource materials were useful. : 3	The resource materials were useful. : 4	The resource materials were useful. : 5
The content was balanced and unbiased.	The content was balanced and unbiased. : 1	The content was balanced and unbiased. : 2	The content was balanced and unbiased. : 3	The content was balanced and unbiased. : 4	The content was balanced and unbiased. : 5
I will be able to apply what I’ve learned to improve health outcomes in my community.	I will be able to apply what I’ve learned to improve health outcomes in my community. : 1	I will be able to apply what I’ve learned to improve health outcomes in my community. : 2	I will be able to apply what I’ve learned to improve health outcomes in my community. : 3	I will be able to apply what I’ve learned to improve health outcomes in my community. : 4	I will be able to apply what I’ve learned to improve health outcomes in my community. : 5
I would recommend this module to a colleague.	I would recommend this module to a colleague. : 1	I would recommend this module to a colleague. : 2	I would recommend this module to a colleague. : 3	I would recommend this module to a colleague. : 4	I would recommend this module to a colleague. : 5

7. Please identify which components of the module were most useful to your clinical practice/teaching.

8. Which were least useful?

9. Did you perceive any degree of commercial bias in any part of the module?

Yes

10. Do you have any suggestions for future module topics?

11. Do you have any suggestions for additional resource materials?

12. We are hoping to conduct a follow-up evaluation on FM Pivot later in the year. May we contact you for a brief follow-up questionnaire or interview at this time? If so, please include your email address here:

13. Any final suggestions/comments?