Participant Survey (EPL Modules)
Please complete this short survey after viewing the learning module. Your answers will help us better understand our learners and how to improve our curriculum for you. We anticipate this survey will take an average of 10-15 minutes.
What is your specialty?
Emergency Medicine
Family Medicine
Internal Medicine
Obstetrics and Gynecology
Other:
Clear selection
In what country do you practice medicine? Please fill in the answer below.
Your answer
If you practice in the United States, do you practice in a rural, suburban, or urban setting? Please respond to the best of you knowledge.
Rural
Suburban
Urban
Do not practice in the United States
Other:
Clear selection
What best describes your practice setting?
Academic
Community clinic
Family planning clinic
HMO
Private Practice
Clear selection
What best describes your practice setting?
Academic
Community clinic
Family planning clinic
HMO
Private Practice
Clear selection
What proportion of your patients are women of reproductive age (15-44 years old)?
Less than 10%
11%-25%
26%-50%
51%-75%
76% or more
Clear selection
What proportion of your patients are women of reproductive age (15-44 years old)?
Less than 10%
11%-25%
26%-50%
51%-75%
76% or more
Clear selection
On average, how many women of reproductive age (15-44 years old) do you treat each week? Please answer to the best of your knowledge.
Less than 10
11-20
21-30
31-40
41-50
51-60
60+
N/A
Clear selection
Do you provide obstetric and prenatal care?
Yes. I provide both obstetric and prenatal care.
No. I provide neither obstetric and prenatal care.
No. I only provide prenatal care.
No. I only provide obstetric care.
Clear selection
Do you perform uterine aspirations in your practice?
Yes
No
Clear selection
Do you provide expectant management in your practice?
Yes
No
Clear selection
If so, where do you perform uterine aspiration? Emergency department, operating room, and/or outpatient setting? Please list all that apply below. If you do not perform uterine aspiration please enter "0".
Your answer
Do you provide medication management in your practice?
Yes
No
Clear selection
Does your practice refrain from providing any of the following treatment options?
Expectant managment
Medication management with misoprostol
Uterine aspiration in an outpatient setting
Uterine aspiration in an emergency room
Uterine aspiration in an operating room
N/A (We do not refrain from providing any of the following treatment options listed above)
Clear selection
What proportion of your patients with early pregnancy loss choose expectant management?
Your answer
What proportion of your patients with early pregnancy loss choose medication management?
Your answer
What proportion of your patients with early pregnancy loss choose uterine aspiration?
Your answer
Up to what gestational age of early pregnancy loss do you provide expectant management? If you do not provide this care please enter 0.
Your answer
Up to what gestational age of early pregnancy loss do you provide uterine aspiration in an outpatient setting? If you do not provide this care please enter 0.
Your answer
Up to what gestational age of early pregnancy loss do you provide medication management? If you do not provide this care please enter 0.
Your answer
Up to what gestational age of early pregnancy loss do you provide uterine aspiration in an operating room? If you do not provide this care please enter 0.
Your answer
Up to what gestational age of early pregnancy loss do you provide uterine aspiration in the Emergency Department? If you do not provide this care please enter 0.
Your answer
If you do perform uterine aspiration in your practice, how many per month? If not, please leave blank.
Your answer
If you encounter major obstacles to providing uterine aspiration in an outpatient setting, please explain below.
Your answer
If you encounter major obstacles to providing uterine aspiration in your Emergency Department, please explain below.
Your answer
How helpful was this module in updating you about early pregnancy loss?
Very helpful
Somewhat helpful
Did not make a difference
Somewhat unhelpful
Very unhelpful
Clear selection
After watching this module, are there changes you would like to make to your practice? If so, please describe below.
Your answer
What did you enjoy about this course? Please describe below.
Your answer
How can this course be improved? Please describe below.
Your answer
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