After participating in this activity, have you implemented or started to implement a change in your practice by any of the following? *

[YES] Integrating knowledge gained at a didactic session.

[YES] Performing a surgical technique based on what I learned or saw demonstrated during an educational session.

[YES] Incorporating non-technical skills and practice-related resources to enhance the health and wellbeing of the cardiothoracic surgical team at my practice.

[YES] Using improved interpersonal communication skills based on what I learned at an educational session.

[NO] I have not made any changes.

Other, please explain:

After participating in this activity, have you implemented or started to implement a change in your practice by any of the following? Other, please explain:

[NO] Why haven’t you implemented any changes in your practice?

The meeting reinforced what I am already doing in practice.

It is not applicable to my practice situation.

Systems-related barriers, please explain*

No practices changes were recommended.

Other, please explain*

[NO] Describe any systems-related barriers or specify other reasons why not.

Please describe how the change(s) you made as a result of attending the course have had an impact on your patient outcomes. *

What quality initiatives will you seek to bring back to your team? *

Please provide overall comments or suggestions about what STS can do to improve this course in the future.

How many years have you been in practice? (Please note if you are still in training.) *

Please indicate your profession. *

Anesthesiologist

Cardiologist

Cardiothoracic Surgeon

Cardiothoracic Surgery Resident

Fellow

General Surgery Resident

Interventional Pulmonologist

Non-RN Data Manager

Nurse

Nurse Practitioner

Perfusionist

PhD/Research Scientist

Physician (Other)

Physician Assistant

Practice Administrator

RN-Data Manager

Vascular Surgeon

Other:

Please indicate your profession. Other:

Which best describes your practice? *

Salaried – academic medicine with an ACGME CT surgery residency program

Salaried – academic medicine (medical school or university)

Salaried – government (national health service, military, VA)

Salaried – hospital employed

Salaried – HMO employed (e.g., Kaiser)

Private Practice – small (1-3 CT surgeons)

Private Practice – large (4 or more CT surgeons)

Other, please explain:

Which best describes your practice? Other, please explain:

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