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?
Clear selection
In what country do you practice medicine? Please fill in the answer below.
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.
Clear selection
What best describes your practice setting?
Clear selection
What best describes your practice setting?
Clear selection
What proportion of your patients are women of reproductive age (15-44 years old)?
Clear selection
What proportion of your patients are women of reproductive age (15-44 years old)?
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.
Clear selection
Do you provide obstetric and prenatal care?
Clear selection
Do you perform uterine aspirations in your practice?
Clear selection
Do you provide expectant management in your practice?
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".
Do you provide medication management in your practice?
Clear selection
Does your practice refrain from providing any of the following treatment options?
Clear selection
What proportion of your patients with early pregnancy loss choose expectant management?
What proportion of your patients with early pregnancy loss choose medication management?
What proportion of your patients with early pregnancy loss choose uterine aspiration?
Up to what gestational age of early pregnancy loss do you provide expectant management? If you do not provide this care please enter 0.
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.
Up to what gestational age of early pregnancy loss do you provide medication management? If you do not provide this care please enter 0.
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.
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.
If you do perform uterine aspiration in your practice, how many per month? If not, please leave blank.
If you encounter major obstacles to providing uterine aspiration in an outpatient setting, please explain below.
If you encounter major obstacles to providing uterine aspiration in your Emergency Department, please explain below.
How helpful was this module in updating you about early pregnancy loss?
Clear selection
After watching this module, are there changes you would like to make to your practice? If so, please describe below.
What did you enjoy about this course? Please describe below.
How can this course be improved? Please describe below.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy