GWEP Training Knowledge Survey

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Site name (If applicable: name of hospital, clinic, CHC, you are attending this program today):*

Name of Presenter*

Training Topic* Please Select Advance Care Planning Cultural and linguistic competency Dementia care Deprescribing/ Appropriate Prescribing and Pharmacovigilance Diabetes Elder abuse Emergency preparedness End-of-life Eye health Fall Prevention and Fall Risk assessment Heart failure/ Other chronic dx Infection prevention LGBTQ care for seniors Long term care Lung disease Mental health Nutrition Opioids Oral Health Population health Reduce hospitalizations/improvements in care Rehabilitation and Long-term Care Placement Social determinants (aging) Medicine, integrated care Telehealth Value-based care, MIPS and cost containment Other

Health professional or student discipline* Please Select Audiology Behavioral Health Dentistry Dietician Medicine Nursing OT Pharmacy Psychiatry PT Public Health Speech pathology Other

Other:*If not applicable, please discard it and write "NA"

Are you a:* Please Select Student Resident Fellow Faculty/clinical administrator/Director Other

Other:*If not applicable, please discard it and write "NA"

Before participating in today's training: How much knowledge do you feel you have currently in this training topic?:* Please Select None - have no knowledge of the content Low - know very little about the content Moderate -basic knowledge but more to learn High - consider myself very knowledgeable

Now that you have completed the training, how much knowledge do you feel you have in this training topic?* Please Select None - have no knowledge of the content Low - know very little about the content Moderate -basic knowledge but more to learn High - consider myself very knowledgeable

Do you think you will apply what you learned today in your role as a health professional?* Please Select Very likely Somewhat likely Not likely

In future training sessions, what would you like to know more about?*

How can we improve this training for future students/professionals?*

Today's presentation was part of a Geriatrics Workforce Enhancement Program grant funded by HRSA (Health Resources and Services Administration.) As part of the grant we are asked to report aggregate information on individuals who participate in grant-sponsored trainings. Answering these questions is voluntary, and you can skip any question you do not wish to answer. Thank you for your help.

Which age group do you belong:* Please Select 19 and under 20-29 30-39 40-49 50-59 60 and over

Gender:* Please Select Male Female Prefer not to answer

Are you a veteran?* Please Select Reservist Veteran No

Ethnicity:* Please Select Hispanic/Latino Not Hispanic/Latino Prefer not to answer

Race:* Please Select White Black or African American Asian American Indian or Alaska Native Native Hawaiian or Pacific Islander Prefer not to answer

Are you from a rural residential background:* Please Select Yes No

Are you from a disadvantaged background:* Please Select Yes No

Are you an underrepresented minority in your profession or professional program?* Please Select Yes No

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