External Learner Clinical Pre-Assessment (Abortion Care)

Instructions: Please respond to the below questions prior to your learning experience at PPGNHI. These will be shared with your clinical preceptor(s) and help us determine how best to meet your needs.

1. Learner Information *This question is required.

First Name

Last Name

Program/Residency Year

2. Tell us about your professional goals. *This question is required.

3. Describe your clinical rotations involving abortion care thus far. Type of rotation, preceptors, service mix:
*This question is required.

4. Approximate number of LARC (IUC, implant) procedures performed or N/A: *This question is required.

5. Comfort level performing pelvic/ bimanual exams:
*This question is required.

6. Comfort level performing reproductive healthcare, contraceptive care, STI’s:
*This question is required.

7. Comfort level with performing MVA and approximate number of procedures done: *This question is required.

8. Comfort level with performing EVA and approximate number of procedures done: *This question is required.

9. What are some goals you would like to accomplish during your time with us?
*This question is required.

10. How best do you learn new skills (visual, auditory, observation, hands-on)?
*This question is required.

11. Is there anything else you would like us to know (special needs, requests)?
*This question is required.