SSI Course Feedback

Course Name

Course Date

Faculty

Candidate Name

Mobile

Phone

Specialty

Country

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Hospital Address

Telephone

Email Address

Please state your position in the hospital

Please state the number of years you have been in practice

Please state the number of cases you perform by yourself per year

None

1-20

21-50

>50

Do you have any additional comments on quality of the whole event

Faculty Speaker

Teaching skills

Very Good

Good

Satisfied

Not Satisfied

Ability to teach a reproducible technique

Very Good

Good

Satisfied

Not Satisfied

Ability to discuss how to avoid complications & answer all questions

Very Good

Good

Satisfied

Not Satisfied

Honest on his own experience

Very Good

Good

Satisfied

Not Satisfied

Ability to build a clinical program

Very Good

Good

Satisfied

Not Satisfied

Know–how to easily approach the participants

Very Good

Good

Satisfied

Not Satisfied

Ready to answer all questions and enter into discussion and debate with participants

Very Good

Good

Satisfied

Not Satisfied

How would you rate the demo session (if applicable)

Excellent

Good

Average

Below Average

What values do you see this course is adding to your practice

What type of additional information would you need

Hotel Accommodation (if applicable)

Excellent

Good

Average

Below Average

Group Dinner (if applicable)

Excellent

Good

Average

Below Average

SSI Staff

Excellent

Good

Average

Below Average

What is ONE KEY LEARNING you have taken away from this event

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Clinical Surgical Training Center

SSI Course Feedback