36C10G18Q0127-002.docx

Training Name:

Training Dates:

Trainer Names:

Attendees:

Summary of Objectives:

Insert Copy of Agenda:

Insert Post-Training Survey Results (template inserted here):

Complete outreach visit assessment for each Basic Skills trainee (template inserted here):

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PWS - post training survey.xlsx Sheet1

Name (Optional)

VISN

Are you or will you be an Academic Detailer? (Circle 1) Yes No

Course evaluation Strongly disagree Disagree Disagree somewhat Undecided Agree somewhat Agree Strongly agree

The training course was well organized

Role playing was an effective way to improve my academic detailing skills

My questions were answered to my satisfaction

The pace of the training was conducive to learning

Enough time was spent discussing topics important to me

Too much time was spent discussing topics NOT important to me

Overall Satisfaction Totally inadequate Very inadequate Barely inadequate Borderline Barely adequate Very adequate Totally adequate

How would you rate this training OVERALL?

ADS Team evaluation

Instructor name:_________________ Strongly disagree Disagree Disagree somewhat Undecided Agree somewhat Agree Strongly agree

The instructors were well organized

The instructors were concerned with how well the trainees were learning

The instructors presented the material well

The instructors provided valuable feedback

Additional Comments (please feel free to add comments about any specific presenations/ instructional styles you thought were good or needed improvement):

Knowledge, Skills, and Attitudes Strongly disagree Disagree Disagree somewhat Undecided Agree somewhat Agree Strongly agree

I am going to apply the academic detailing skills I've learned within the next week.

Author: Author:

I added some questions about when they expect to use their academic detailing skills

I am going to apply the academic detailing skills I've learned within the next 2 weeks.

I am going to apply the academic detailing skills I've learned within the next 4 weeks.

I am going to apply the academic detailing skills I've learned within the next 3 months.

I am confident about using the academic skills that I've learned.

I believe that academic detailing can align providers to best practices.

My local colleagues have been successful with academic detailing.

Local providers have a positive opinion about academic detailing.

My local facility supports academic detailing.

I know how to access academic detailing resources.

I feel confident that I can change a provider's behavior.

Additional Comments:

Academic Detailing Immediate Post-Training Survey

Objectives:

1) Assess the trainee’s perception of the training program’s value

2) Assess the knowledge, skills, and attitudes of the trainees on academic detailing

3) Assess whether the trainees will use the skills in the field immediately after completing the training

Description:

The following questions are in regards to the most recent academic detailing training you received.

Please indicate if you agree or disagree with each of the statements below by clicking one of the ciricles. Only one circle can be selected for each statement.

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ADS Outreach Visit Assessment.docx Academic Detailing (AD) Outreach Visit Assessment

Detailer name:

Date:

Type of session:

Poor or not addressed

Fair

Good

Excellent

N/A

Average score**

Introduction

1. Introduced themselves and/or summarized last visit and asked about experiences or progress made

2. Clearly stated the reason/purpose for the visit

3. Verified time available/allotted for appointment

Comments:

Needs assessment

1. Used open-ended questions to gain an understanding of current practice/management strategies

2. Identified and managed barriers/objections

3. Discussed at least 1 key message but did not overwhelm the provider with too many key messages

4. Used AD techniques (e.g. EPE, 3Fs, reflections) to engage clinician in discussion

5. Resisted the righting reflex (avoided phrases like: “yes, but”, “but what about”, “have you tried”)

Comments:

Poor or not addressed

Fair

Good

Excellent

N/A

Average score**

Summary & Close

1. Summarized key items discussed

2. Obtained commitment from the clinician to implement a change in behavior(s)

3. Asked if there were additional questions/concerns

4. Thanked the provider for his/her time

5. Identified plan for follow-up (e.g. future appt)

Comments:

Overall Review of Detail Visit

1. The detailer’s body language, tone and/or eye contact seemed appropriate

2. The provider seemed engaged

3. Overall, the encounter embodied the elements of a successful AD visit

4. To the best of your judgment, this detail session resulted in building/maintaining a positive relationship with the clinician

Extremely unlikely

Unlikely

Likely

Extremely Likely

5. To the best of your judgment, this detail session will result in a change in behavior

Extremely unlikely

Unlikely

Likely

Extremely Likely

Comments:

Total Score*

*Total score may be used to assess academic detailing performance over time (e.g. improving skills = increase in total score). Disclaimer: total score has not been directly associated with academic detailing success; **Average Score may be used to help identify a weakness or area needed for improvement within the academic detailing visit