eSIM Provincial Participant Evaluation
Your feedback is confidential and used for system & organizational improvement, not individual performance management.
Demographic Questions
Booking Number
*
If your booking number includes eSIM with just four numbers please enter a leading '0' (eSIM1234 would be entered as eSIM01234)
Primary Facilitator Name
*
What is your professional designation?
*
Please Select
Nursing
Respiratory Therapist
Allied Health - All professional designations outside of RTs
HCA
Physician
Nurse Practitioner
Undergraduate Student
Medical Student
EMS
Resident/Fellow
Dentist
Dental Assistant
Admin/Clerical
Protective Services
Other
What Zone are you Located?
*
Edmonton
Central
Calgary
South
North
North Zone
*
Please Select
Athabasca Community Health Services
Barrhead Healthcare Centre
Bonnyville Healthcare Centre
Edson Healthcare Centre
Grande Prairie Regional Hospital
High Prairie Health Complex
Hinton Healthcare Centre
Lac La Biche Healthcare Centre
Northern Lights Regional Health Centre
Peace River Community Health Centre
Wabasca Healthcare Centre
Westlock Healthcare Centre
Whitecourt Healthcare Centre
Other
North Zone
Athabasca Community Health Services
Barrhead Healthcare Centre
Bonnyville Healthcare Centre
Edson Healthcare Centre
Grande Prairie Regional Hospital
High Prairie Health Complex
Hinton Healthcare Centre
Lac La Biche Healthcare Centre
Northern Lights Regional Health Centre
Peace River Community Health Centre
Wabasca Healthcare Centre
Westlock Healthcare Centre
Whitecourt Healthcare Centre
Other, please specify
Edmonton Zone
*
Please Select
Alberta Hospital Edmonton
Devon General Hospital
Edmonton General Hospital
East Edmonton Health Centre
Fort Saskatchewan Community Hospital
Glenrose Rehabilitation Hospital
Grey Nuns Community Hospital
HSERC
Lakewood Community Health Centre
Leduc Community Hospital
Lois Hole Hospital for Women
Misericordia Community Hospital
Northeast Community Health Centre
Royal Alexandra Hospital
St. Joseph's Auxiliary Hospital
Strathcona Community Hospital
Sturgeon Community Hospital
UAH - Cross Cancer Institute
UAH - Kaye Edmonton Clinic
UAH - Mazankowski Heart Institute
UAH - Stollery Children's Hospital
UAH - Walter Mackenzie Centre
Villa Caritas
Westview Health Centre
Youville Home
Other
Edmonton Zone
Alberta Hospital Edmonton
Devon General Hospital
Edmonton General Hospital
East Edmonton Health Centre
Fort Saskatchewan Community Hospital
Glenrose Rehabilitation Hospital
Grey Nuns Community Hospital
HSERC
Lakewood Community Health Centre
Leduc Community Hospital
Lois Hole Hospital for Women
Misericordia Community Hospital
Northeast Community Health Centre
Royal Alexandra Hospital
St. Joseph's Auxiliary Hospital
Strathcona Community Hospital
Sturgeon Community Hospital
UAH - Cross Cancer Institute
UAH - Kaye Edmonton Clinic
UAH - Mazankowski Heart Institute
UAH - Stollery Children's Hospital
UAH - Walter Mackenzie Centre
Villa Caritas
Westview Health Centre
Youville Home
Other, please specify
Central Zone
*
Please Select
Camrose (St. Mary's Hospital)
Castor (Our Lady of the Rosary Hospital)
Drayton Valley Hospital & Care Centre
Drumheller Health Centre
Killam Health Centre
Mundare (Mary Immaculate Care Centre)
Olds Hospital & Care Centre
Ponoka Hospital & Care Centre
Provost Health Centre
Red Deer Regional Hospital Centre
Sundre (Myron Thompson Health Centre)
St. Mary's Health Care Centre (Trochu)
Three Hills Health Centre
Vegreville (St. Joseph's General Hospital)
Wetaskiwin Hospital & Care Centre
Other
Central Zone
Camrose (St. Mary's Hospital)
Castor (Our Lady of the Rosary Hospital)
Drumheller Health Centre
Killam Health Centre
Mundare (Mary Immaculate Care Centre)
Olds Hospital & Care Centre
Ponoka Hospital & Care Centre
Provost Health Centre
Red Deer Regional Hospital Centre
Sundre (Myron Thompson Health Centre)
St. Mary's Health Care Centre (Trochu)
Three Hills Health Centre
Vegreville (St. Joseph's General Hospital)
Wetaskiwin Hospital & Care Centre
Other, please specify
Calgary Zone
*
Please Select
Airdrie Urgent Care
Arthur J.E. Child Comprehensive Cancer Centre
Banff Mineral Springs Hospital
Canmore
Cochrane
Foothills Medical Centre
High River
Okotoks
Peter Lougheed Centre
Richmond Road Diagnostic Treatment Centre
Rockyview General Hospital
Sheldon Chumir Urgent Care
South Health Campus
South Urgent Care
Strathmore
Other
Calgary Zone
Airdrie Urgent Care
Banff Mineral Springs Hospital
Calgary Cancer Centre
Canmore
Cochrane
Foothills Medical Centre
High River
Okotoks
Peter Lougheed Centre
Richmond Road Diagnostic Treatment Centre
Rockyview General Hospital
Sheldon Chumir Urgent Care
South Health Campus
South Urgent Care
Strathmore
Other, please specify
South Zone
*
Please Select
Bassano
Brooks
Cardston
Chinook Regional Hospital
Crowsnest Pass
Fort McLeod
Medicine Hat Regional Hospital
Milk River
Pincher Creek
Raymond
St. Joseph's Home (Medicine Hat)
St. Michael's Health Centre (Lethbridge)
St. Therese Villa (Lethbridge)
Taber
Other
South Zone
Bassano
Brooks
Cardston
Chinook Regional Hospital
Crowsnest Pass
Fort McLeod
Medicine Hat Regional Hospital
Milk River
Pincher Creek
Raymond
St. Joseph's Home (Medicine Hat)
St. Michael's Health Centre (Lethbridge)
St. Therese Villa (Lethbridge)
Taber
Other, please specify
Did you attend this session:
*
In-person
Online
What primary simulation activity did this session fit into?
*
In-person Simulation - Team Training and/or Orientation
In-Person Simulation - System Integration Simulation, Process Walkthroughs & Commissioning Simulation
In-Person Simulation - Visually Enhanced Mental Simulation (VEMS)
In-Person Simulation - Academic Institution (PGME/UGME)
What primary simulation activity did this session fit into?
*
Online Simulation - Digital Platform Based (MURAL)
Online Simulation - SIS, Process Walkthrough, Tabletops
Online Simulation - Other
Have you participated in at least one simulation session over the last 12 months, prior to this session?
*
Yes
No
If yes, how many sessions have you participated in over the last 12 months?
*
1 to 3 sessions
4 to 6 sessions
More than 6 sessions
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Learning Objectives
After the session I feel more confident in my ability to....
*
Rows
Strongly Agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly Disagree (1)
Not Applicable
Participate as a leader or follower.
Delegate or be receptive to direction.
Understand my role and fulfil my responsibility within an interprofessional team.
Recognize a change in clinical status or deteriorating condition.
Work collaboratively with patients and families to improve experience.
Communicate effectively by addressing members directly, repeating back and seeking clarity.
Refer to established protocols and checklists for the procedure/intervention.
Know when and how to seek additional resources.
After the session I feel more confident in my ability to....
*
Rows
Strongly Agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly Disagree (1)
Not Applicable
Understand my role and fulfil my responsibility within a team.
Communicate effectively with team members.
Recognize a change in clinical status or deteriorating condition.
Recognize when additional support or resources are needed.
Work collaboratively with patients and families.
Please check the box that best reflects your rating:
*
Rows
Strongly Agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly Disagree (1)
Not Applicable
The session objectives were clear and achievable.
The content was relevant to my learning needs.
I am confident I can apply what I learned to my practice.
The simulation experience will help me provide safer, higher-quality patient care.
During today’s simulation, I observed one or more system issues or safety risks that could affect patient or staff safety.
*
Yes
No
Unsure
Which category best describes the issue(s) you observed? (Select all that apply)
*
Equipment (devices, supplies, technology)
Environment/layout (physical space, room setup, or design factors)
Tasks or workflow
Resources/Guidelines/Protocols (outdated, inaccessible, unclear, or incorrect)
Staffing
Teamwork/communication
Organizational/policy issues
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Quality of the Facilitation
Name of Primary Facilitator
*
First Name
Last Name
Please check the box that best reflects your rating for this facilitator:
*
Rows
Strongly Agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly Disagree (1)
Not Applicable
OVERALL IMPRESSION of the quality of simulation facilitation was excellent (technology, scenario design and fidelity, simulation facilitation, prebriefing, and debriefing)
Please check the box that best reflects your rating for this facilitator:
*
Rows
Strongly Agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly Disagree (1)
Not Applicable
The primary facilitator was able to effectively use and troubleshoot equipment and/or materials
The primary facilitator clearly outlined expectations during the prebrief
The simulation scenario was realistic and relevant to my area of practice
The primary facilitator managed time and was organized
I felt psychologically safe to participate and share my thoughts in the debrief
The debrief helped consolidate learning and identify strategies for improvement
Primary Facilitator Total Score
What were 1–2 strengths of the primary facilitator?
*
What could be improved in future sessions?
Did your simulation have another primary facilitator?
*
Yes
No
Name of additional primary facilitator:
First Name
Last Name
Please check the box that best reflects your rating for this facilitator:
*
Rows
Strongly Agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly Disagree (1)
Not Applicable
OVERALL IMPRESSION of the quality of simulation facilitation was excellent (technology, scenario design and fidelity, simulation facilitation, prebriefing, and debriefing)
Please check the box that best reflects your rating for this facilitator:
*
Rows
Strongly Agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly Disagree (1)
Not Applicable
The primary facilitator was able to effectively use and troubleshoot equipment and/or materials
The primary facilitator clearly outlined expectations during the prebrief
The simulation scenario was realistic and relevant to my area of practice
The primary facilitator managed time and was organized
I felt psychologically safe to participate and share my thoughts in the debrief
The debrief helped consolidate learning and identify strategies for improvement
Additional Primary Facilitator Total Score
What were 1–2 strengths of the primary facilitator?
*
What could be improved in future sessions?
Please check the box that best reflects your rating:
*
Rows
Strongly Agree (5)
Agree
(4)
Neutral (3)
Disagree (2)
Strongly Disagree (1)
Not Applicable
The overall educational experience of the simulation event was excellent.
The simulation scenarios content and debriefing were appropriate for my practice and specialty.
The facilities, equipment and setting of the simulation was appropriate.
This simulation event was well organized and effective use of my time.
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Staff Recruitment/Retention
Please check the box that best reflects your rating
*
Rows
Strongly Agree (5)
Agree
(4)
Neutral (3)
Disagree (2)
Strongly Disagree (1)
Not Applicable
Participation in simulation contributes to my job satisfaction.
Having access to simulation-based education makes me feel valued and supported in my role.
I am more likely to stay in my current role if I can participate in simulation-based education to maintain competence of my clinical skills.
Having opportunities to participate in simulation-based education is important in applying for a new position.
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Application of Virtual Simulation
Please check the box that best reflects your rating
*
Rows
Strongly Agree (5)
Agree
(4)
Neutral (3)
Disagree (2)
Strongly Disagree (1)
Not Applicable
The virtual technology was reliable and easy to use.
The virtual simulation allows me to demonstrate effectively the application of my knowledge and skills.
The virtual format supported effective communication and teamwork.
I was able to stay engaged and focused throughout the session.
I would recommend that virtual simulation be utilized in future programs/courses.
Please add any additional comments or suggestions relating to the strengths or improvements of the virtual simulation delivery (e.g. technical issues)
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VEMS In-Person
Please check the box that best reflects your rating
*
Rows
Strongly Agree (5)
Agree
(4)
Neutral (3)
Disagree (2)
Strongly Disagree (1)
Not Applicable
The tabletop (VEMS) simulation was easy to use and understand.
The prebrief information allowed enough time to become familiarized with and understand how to use tabletop exercises.
The case information was realistic and engaging
The tabletop VEMS allowed me to apply my knowledge and skills.
The tabletop VEMS format supported discussion and teamwork in the debrief
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System Integration Simulation
Please check the box that best reflects your rating
Who do you recommend to coordinate follow-up on the issue(s) identified?
*
My department/unit
Senior leadership/management
Quality & Patient Safety
Not sure
Another department (specify)
*
Rows
Strongly Agree (5)
Agree
(4)
Neutral (3)
Disagree (2)
Strongly Disagree (1)
Not Applicable
The issue(s) I observed have the potential to impact
patient or staff safety.
I am clear on who should be responsible for following up on the issue(s) identified.
Please describe the most significant system issue you observed during the simulation including where in the process it occurred if possible.
*
What suggestions would you have to improve the process?
*
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The content presented in the simulation session was evidence informed (i.e. scientifically balanced).
*
Yes
No
Please expand on any key learnings from today's simulation session and areas for improvement.
Question ONLY for Physicians
Please indicate which CanMEDS roles you felt were addressed during this educational activity (select all that apply):
*
Medical Expert
Communicator
Collaborator
Leader
Health Advocate
Scholar
Professional
Did you perceive any degree of commercial or inappropriate bias in any part of the simulation program?
*
Yes
No
Is this a simulation activity, in which CPD Credits may be claimed? (If unsure, please check with your facilitator)
*
Yes
No
Do you require a certificate for your participation in the simulation today?
*
Yes
No
Please Select the Simulation Activity:
Please Select
Calgary Emergency Department Staff Simulation Program
Calgary Zone Diagnostic Imaging Simulation Program
David Schiff NICU
Edmonton Zone Emergency Department Annual Simulations
Edmonton Zone Neonatal Emergency Resuscitation in the Emergency Department (ED)
Edmonton Zone Trauma Program Annual Simulations
Fort Saskatchewan Community Hospital Emergency Department Simulation
FMC Anesthesia Program
FMC NICU Simulation Program
Grey Nuns Emergency Department Simulation
Indigenous Themed Simulation
Misericordia ICU Simulation Program
Misericordia Perioperative Simulation Program
Phillip C. Etches NICU RST Simulation
PLC Hospitalists Simulation Program
Quality Improvement/SIS (Unaccredited)
Rural Emergency Department Simulation Program
Rural Perioperative Simulation Program
SHC Anesthesia/Surgical Simulations
SHC Hospitalists Simulation Program
Southern Alberta Neonatal Transport Service (SANTS) Outreach Simulation
Stollery Pediatric Emergency Staff Simulation
Strathcona Community Hospital Emergency Department Simulation
WestView Emergency Department Simulation
Urgent Care Simulations
Hours of Participation
Section
Submit
Should be Empty: