APP-QSAT • APP-QSAT • APP-QSAT • Demographics WHAT IS YOUR GENDER? * MALE FEMALE NON-BINARY I PREFER NOT TO SAY WHAT IS YOUR AGE? * 21-29 30-39 40-49 50-59 60 or older WHAT IS YOUR CURRENT DEGREE? * BACHELORS MASTERS DOCTORATE MD PHD STUDENT DOCTORATE STUDENT PHD COMMENT BOX CURRENT BOARD LICENSE * NP PA RN DO MD PARAMEDIC PHARMACIST COMMENT BOX DESCRIPTION OF ROLE * SELECT ALL THAT APPLY PROGRAM DIRECTOR(S) OF RN RESIDENCY/FELLOWSHIP PROGRAM DIRECTOR(S) OF APP RESIDENCY/FELLOWSHIP PROGRAM DIRECTOR(S) OF PHARMACY RESIDENCY PROGRAM DIRECTOR(S) OF MEDICAL RESIDENCY/FELLOWSHIP FACULTY IN PHARMACY RESIDENCY FACULTY WITHIN A RN RESIDENCY/FELLOWSHIP FACULTY WITHIN AN APP RESIDENCY/FELLOWSHIP APP IN CLINICAL SETTING FACULTY IN MEDICAL RESIDENCY/FELLOWSHIP APP IN EDUCATION RN IN CLINICAL SETTING RN IN EDUCATION PARAMEDIC IN CLINICAL SETTING PARAMEDIC IN EDUCATION PHARMACIST IN CLINICAL SETTING PHARMACIST IN EDUCATION COMMENT BOX ROLE IN SIMULATION * EDUCATOR WITHIN SIMULATION DIRECTOR OF A SIMULATION CENTER CURRENTLY NOT ENGAGED IN SIMULATION COMMENT BOX WHAT IS(ARE) YOUR SPECIALITY(IES)? * SELECT ALL THAT APPLY EMERGENCY CRITICAL CARE HOSPITALIST MED/SURG PALLIATIVE ONCOLOGY SURGICAL SPECIALTIES PSYCHIATRIC DERMATOLOGY PEDIATRIC CRITICAL CARE PEDIATRIC ONCOLOGY PEDIATRIC MED/SURG PEDIATRIC PMR PEDIATRIC EMERGENCY PEDIATRIC BEHAVIORAL PEDIATRIC CARDIOLOGY CRNA MIDWIFE WOMENS HEALTH FAMILY MEDICINE CARDIOLOGY COMMENT BOX YEARS IN YOUR SPECIALITY(IES) * 1-5 6-10 11-15 16-20 21-25 26-30 DO YOU HAVE ANY CERTIFICATION AS A SIMULATION EDUCATOR? * YES NO PLEASE PROVIDE NAME OF CERTIFICATION OR N/A HAVE YOU TAKEN ANY COURSES TO EDUCATE IN SIMULATION? * YES NO PLEASE PROVIDE NAME OF ORGANIZATION FOR COURSES OR N/A HOW MANY YEARS' EXPERIENCE IN SIMULATION? * 0 1-5 6-10 11-15 16-20 21-25 26-30 NAME OF ORGANIZATION(S) YOU ARE AFFILIATED WITH? * Thank you!