APP-QSAT • APP-QSAT • APP-QSAT • Name * First Name Last Name Email * Subject * Message * Survey Option 1 Strongly Disagree Disagree Neutral Agree Strongly Agree Option 2 Strongly Disagree Disagree Neutral Agree Strongly Agree Checkbox * male female non-binary Thank you! Your Demographics Filling out this form allows us better understand who you are. Help us help you. THANK YOU! Email * What is your gender? * Male Female Non-binary I prefer not to say What is your age range? * 21-29 30-39 40-49 50-59 60 or older What is the highest degree you have received? * Bachelors Masters Doctorate MD PhD Current Board License * NP PA RN MD Paramedic Your role in program * Program director(s) of RN residency/fellowship Program director(s) of APP residency/fellowship Faculty within a RN residency/fellowship Faculty within a APP residency/fellowship Your role in simulation * Educator within simulation Director of a simulation center Currently not engaged in simulation What is your specialty? * Emergency Critical care Hospitalist Med/Surg Palliative Oncology Surgical specialties Psychiatric Dermatology Pediatrics critical care Pediatrics oncology Pediatrics med/surg Pediatric PMR Pediatric emergency Pediatric behavioral Years in your specialt(y/ies) * 1-5 6-10 11-15 16-20 21-25 26-30 Do you have any certification as a simulation educator? * Yes No Have you taken any courses in to educate in simulation? * Yes No Provide name of organization for course * What is your years' experience in simulation? * 1-5 6-10 11-15 16-20 21-25 26-30 30+ Name of organization(s) you are affiliated with * Thank you!
