Block 1 Feedback Survey · Urgent Care Upskilling Program

Participant details

Participant ID / Name (optional) Date Primary practice setting Years in practice

Section 1 — Overall Block 1 Experience

1 = Strongly Disagree · 2 = Disagree · 3 = Neutral · 4 = Agree · 5 = Strongly Agree · N/A = Not Applicable

Section 2 — Day 1 Didactic Lectures

Rate each lecture you attended. 1 = Poor · 2 = Fair · 3 = Good · 4 = Very Good · 5 = Excellent

Which lecture did you find most valuable, and why? Was any lecture unclear, too rushed, or pitched at the wrong level? Please specify which and what would improve it.

Section 3 — Day 1 Hands-On Skill Stations

Rate each of the five rotation stations you attended. 1 = Poor · 2 = Fair · 3 = Good · 4 = Very Good · 5 = Excellent

1 = Strongly Disagree · 2 = Disagree · 3 = Neutral · 4 = Agree · 5 = Strongly Agree · N/A = Not Applicable

Which station would you most like more time on?

Please comment on any station where equipment, time or instruction fell short.

Section 4 — Day 2: Wound Management & Suturing

1 = Poor · 2 = Fair · 3 = Good · 4 = Very Good · 5 = Excellent

1 = Strongly Disagree · 2 = Disagree · 3 = Neutral · 4 = Agree · 5 = Strongly Agree · N/A = Not Applicable

Was the suturing workshop duration:

Any additional comments on the Day 2 wound care and suturing sessions?

Section 5 — Faculty

1 = Strongly Disagree · 2 = Disagree · 3 = Neutral · 4 = Agree · 5 = Strongly Agree · N/A = Not Applicable

Please name any faculty member whose teaching you found particularly effective, and describe what made it work.

Section 6 — Venue, Facilities & Organisation

1 = Strongly Disagree · 2 = Disagree · 3 = Neutral · 4 = Agree · 5 = Strongly Agree · N/A = Not Applicable

Please describe any problems with the venue, facilities or organisation, and how they affected your learning.

Section 7 — Assessment (Pre-course MCQ)

1 = Strongly Disagree · 2 = Disagree · 3 = Neutral · 4 = Agree · 5 = Strongly Agree · N/A = Not Applicable

Section 8 — Looking Ahead to Block 2

Which topics would you most like emphasized in Block 2? (Tick all that apply)

Is there anything from Block 1 you would like revisited or reinforced during Block 2? Are there any topics or skills NOT currently covered that you would like added to the program?

Section 9 — Open Feedback

What worked best about Block 1? What should we keep exactly as it is? What was least effective, and what specific change would you make? Any other comments you would like to share.

Section 10 — Testimonial

We would be grateful for a short testimonial about your experience. With your permission, this may be used in program reports, accreditation submissions and promotional material for future cohorts.

In a few sentences, how would you describe this course to a colleague considering it?

May we quote your testimonial?

Signature (if consenting to attribution)