Clinical Skills Pre-Course Self-Assessment Form
Please rate your current readiness and experience in key clinical skills before the course begins.
Full Name
*
First Name
Last Name
How confident do you feel in your overall clinical skills?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Please rate your current experience with the following clinical skills:
*
Rows
No experience
Some experience
Comfortable
Proficient
Taking patient history
1
2
3
4
Performing physical examination
5
6
7
8
Basic life support (BLS)
9
10
11
12
Aseptic technique
13
14
15
16
Venipuncture/IV insertion
17
18
19
20
Have you previously attended a clinical skills course?
*
Yes
No
What are your main learning goals for this course?
How comfortable are you working in a team during clinical procedures?
*
Not comfortable
1
2
3
4
Very comfortable
5
1 is Not comfortable, 5 is Very comfortable
Please rate your ability to communicate effectively with patients.
*
Needs improvement
1
2
3
4
Excellent
5
1 is Needs improvement, 5 is Excellent
How prepared do you feel to handle emergencies in a clinical setting?
*
Not prepared
1
2
3
4
Very prepared
5
1 is Not prepared, 5 is Very prepared
Do you have any specific concerns or questions about the upcoming course?
Submit Self-Assessment
Should be Empty: