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SSEHV Introductory Workshop for Healthcare Professionals Registration & Pre-Workshop Questionnaire
Name *
Specialty *
Are you aware of the Sathya Sai Education in Human Values program? Please choose one.
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Do you think the practice of  values is relevant to the practice of medicine?  Please choose a number on the following scale: 1 is “not important”; 5 is “vitally important”.
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If you chose #3 or greater in the previous question, name three  values that you think are relevant to our profession.
How frequently do you think human values should be used in day-to-day encounters with patients, their families and co-workers? Please choose one.
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How comfortable are you in talking about human values at your workplace? Please choose a number on the following scale: 1 is “not comfortable at all”; 5 is “very comfortable”.
Not Comfortable
Very Comfortable
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What is your goal in attending the workshop? Please explain briefly
Have you ever felt burnt-out at work?
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If so, how would you grade your degree of burn-out at its worst? Please choose a number on the following scale: 1 is “not at all burnt-out”; 5 is “extremely burnt-out”.
Not at all burnt-out
Extremely burnt-out
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What do you think are the top two most frequent causes for burnout in your profession?
Please list three measures you take to deal with burnout.
Years in Practice
Practice setting
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 I consent to the Institute of Sathya Sai Education-USA or its designated and authorized person(s) taking digital images, and/or audio or video recordings when I am engaged in SSEHV/EHV-related activities. *
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