Alcohol Screening and
Brief Intervention Curriculum

Curriculum Evaluation
What is your position?
What is your specialty?
 
What is your primary focus?
 
What is your training status?
 
Are you:
Male
Female
Are you Hispanic or Latino?
No
Yes
Do you primarily consider yourself:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Other (specify)
Is English your first language?
No
Yes
What year did you complete your residency or clinical training?
  (yyyy)
  I have not completed my residency or clinical training
Do you consider yourself to have expertise in the diagnosis and management of alcohol problems?
No
Yes

Please rate the curriculum using the scale below:

Slides:
Content
poor_ fair_ good_ very_good_ excellent  
Design
poor_ fair_ good_ very_good_ excellent  
Content of speaker notes below slides
poor_ fair_ good_ very_good_ excellent  
Videos:
Patient/physician discussion
poor_ fair_ good_ very_good_ excellent  
Patient debrief at the end of the case
poor_ fair_ good_ very_good_ excellent  
Website:
Content
poor_ fair_ good_ very_good_ excellent  
User-friendliness
poor_ fair_ good_ very_good_ excellent  
What portion(s) of the curriculum have you used or do you plan to use? (check all that apply)
  Slides

Speaker notes below slides

 Video None
Case1 (Ask)
Case2 (Assess)
Case3 (Advise)
In what setting(s) have you used or do you plan to use the curriculum?(check all that apply)
For my own learning
Resident conference, seminars, etc
Medical student courses or conferences
CME courses
Grand rounds
Morning report
Inpatient attending rounds
Teaching while providing clinical care (e.g. inpatient or out patient precepting)
Other
I do not plan to use the curriculum
Is there anything else the curriculum should cover to facilitate the incorporation of screening, assessment, and brief intervention into your practice?
 
Is there anything else the curriculum should cover to facilitate the teaching of this topic?
 
Please provide any additional feedback.