Transition Care for Residency Learning Collaborative - Initial Questionnaire
Thank you for your interest in participating in this learning collaborative to improve transition care training for residents. We are looking for a range of residency programs from small to large, rural to urban, and those with no transition care training currently embedded in their program to those with significant experience in transition care. Please fill out the form below to your best ability and we will contact you with more information about getting started in the collaborative.
BASIC PROGRAM INFORMATION
Program Name/Institution *
Your answer
Is your program ACGME-accredited? *
Program Director Name
Your answer
Transition Care Faculty Champion (TCFC) Name *
Your answer
TCFC Phone *
Your answer
TCFC Email *
Your answer
PROGRAM DEMOGRAPHICS
Total Number of Residents *
Your answer
Average Number of Residents/Cohort *
Your answer
Total Number of Core Faculty (as defined by ACGME) *
Your answer
Which best describes your clinic setting? *
Required
Which is the demographic make up of your clinic community and surrounding community? Please select as many as appropriate. *
Required
What racial/ethnic groups are served in your clinic? Please select as many as appropriate. *
Required
Does your program currently use any tools for supporting transition of youth to adult care? *
If yes, please briefly describe these tools here:
Your answer
Does your program currently provide any training related to the transition of youth to adult care? *
If yes, is this training on transition care a mandatory component? *
If yes, how many hours of transition care training is provided?
Your answer
If yes, please briefly describe the transition care training that is provided.
Your answer
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