Western University Department of Obstetrics and Gynaecology

Grand Rounds Evaluation Form

 

After completing the form, press "Send E-mail" and it will be sent to Jennifer Cordick in the Dept office.  You should receive a confirmatory statement if the form transmits properly.  Don't worry if the confirm says it has been sent to Jim Silcox. This is just a screening mechanism for false spam evaluations. Trust him. He will forward it. Required responses are marked with an asterisk. Note: if you do not fill in the required sections, the form will not be sent. "Reset Message" erases all the completed segments of the form and allows you to start a new submission.  By submitting this form, you are verifying that you were in attendance at the rounds that you are evaluating.

 

Your name*

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Date of round*

We would appreciate your feedback regarding this Grand Rounds presentation. Please click the appropriate radio button for the points you wish to give for each heading:

USEFUL RELEVANT

POOR 1 POOR 2 SATISFACTORY 3 SATISFACTORY 4 SATISFACTORY 5 EXCELLENT 6 EXCELLENT 7

CONTENT

POOR 1 POOR 2 SATISFACTORY 3 SATISFACTORY 4 SATISFACTORY 5 EXCELLENT 6 EXCELLENT 7

FORMAT/DELIVERY

POOR 1 POOR 2 SATISFACTORY 3 SATISFACTORY 4 SATISFACTORY 5 EXCELLENT 6 EXCELLENT 7

OVERALL SATISFACTION

POOR 1 POOR 2 SATISFACTORY 3 SATISFACTORY 4 SATISFACTORY 5 EXCELLENT 6 EXCELLENT 7

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