Block 2 Feedback Survey · Urgent Care Upskilling Program

Participant details

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

Section 1 — Overall Block 2 Experience

Please rate your level of agreement with each statement:

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

Section 2 — Day 1 Didactic Lectures

Please rate each lecture you attended. If you did not attend a session, leave that row blank.

Please circle one number in each column. 1 = Poor · 2 = Fair · 3 = Good · 4 = Very Good · 5 = Excellent

Content = relevance and depth of material · Delivery = clarity, pace and teaching quality · Faculty = knowledge, approachability and responsiveness · Usefulness = applicability to your daily practice

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

Section 3 — Case-Based Simulation Scenarios

Please rate each of the five simulation scenarios.

Please circle one number in each column. 1 = Poor · 2 = Fair · 3 = Good · 4 = Very Good · 5 = Excellent

Content = relevance and depth of material · Delivery = clarity, pace and teaching quality · Faculty = knowledge, approachability and responsiveness · Usefulness = applicability to your daily practice

Simulation design and debriefing

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

Q1. Which scenario was most valuable to your practice?

Q2. How was the balance of active participation versus observation?

Please comment on the simulation scenarios — realism, difficulty, debriefing quality, or anything that would improve them.

Section 4 — Assessment (Day 2)

Post-course MCQ

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

Practical (OSCE-style) examination

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

Q3. Did you experience any of the following during the practical exam?

Tick all that apply. This helps us improve exam fairness for future cohorts.

Please describe any concerns about the fairness, organisation or conduct of the assessments.

Section 5 — Faculty

Across Block 2 as a whole, the 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

Please rate the following:

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 — The Program as a Whole

This section covers all four days across both blocks.

Overall program evaluation

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

Q4. Overall, how would you rate the program?

Q5. How likely are you to recommend this program to a colleague?

On a scale of 0 (not at all likely) to 10 (extremely likely), please circle one.

Section 8 — Impact on Practice

Name one specific thing you will do differently in your practice as a result of this course. Which single skill or topic has been most immediately useful to you?

Q6. Do you feel adequately prepared to apply these skills in your practice setting?

If not fully prepared, what additional support, supervision or resources would you need? (required unless you selected "Fully prepared" above)

Q7. What follow-up would be most valuable to you?

Tick all that apply.

Section 9 — Open Feedback

What worked best about the program overall? What should we keep exactly as it is? What was least effective, and what specific change would you make for the next cohort? What topics or skills should be added to future iterations of this program? Any other comments you would like to share.

Section 10 — Testimonial

We would be grateful for a testimonial about your experience of the program. 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 program to a colleague considering it? (you may wish to mention what you gained, what stood out, or how it has changed your practice) If you can, share a specific example of how this course has already affected — or will affect — the care you provide. (concrete examples are the most powerful form of testimonial — please do not include any patient-identifiable details)

Q8. May we quote your testimonial?

Q9. Would you be willing to be contacted about a short video or written testimonial?

Q10. Name and signature (required only if you selected "Yes — with my full name and job title" above)