GRADUATE SURVEY
The primary goal of an Anesthesiologist Assistant Education program is to prepare the graduate to function as a competent
Anesthetist. This survey is designed to help the program faculty determine the strengths and areas for improvement for our
program. All data will be kept confidential and will be used for program evaluation purposes only.
BACKGROUND INFORMATION:
Name of Graduate:
Length of employment at time of evaluation:
years and
months.
Name (if different from that on the cover):
INSTRUCTIONS: Consider each item separately and rate each item independently of all others. Circle the rating
that indicates the extent to which you agree with each statement. Please do not skip any rating. If you do not know
about a particular area, please circle N/A.
5=Strongly Agree
4 =Generally Agree
3 =Neutral (acceptable)
2 =Generally Disagree
1 =Strongly Disagree N/A =Not Applicable
I. KNOWLEDGE BASE (Cognitive Domain)
THE PROGRAM:
A. Helped me acquire the anesthesia care knowledge
necessary to function in a healthcare setting.
5
4
3
2
1
N/A
B. Helped me acquire the general medical knowledge
base necessary to function in a healthcare setting.
5
4
3
2
1
N/A
C. Prepared me to collect data from charts and patients.
5
4
3
2
1
N/A
D. Prepared me to interpret patient data.
5
4
3
2
1
N/A
E. Prepared me to evaluate diagnostic findings in order
to perform appropriate anesthetic.
5
4
3
2
1
N/A
5
4
3
2
1
N/A
F.
Trained me to use sound judgment while functioning
in a healthcare setting.
Comments:
INSTRUCTIONS: Consider each item separately and rate each item independently of all others. Circle the rating
that indicates the extent to which you agree with each statement. Please do not skip any rating. If you do not know
about a particular area, please circle N/A.
5=Strongly Agree
4 =Generally Agree
3 =Neutral (acceptable)
2 =Generally Disagree
1 =Strongly Disagree N/A =Not Applicable
II. CLINICAL PROFICIENCY (Psychomotor Domain)
THE PROGRAM:
G. Prepared me to perform a broad range of anesthetics in the following specialty in which I trained (circle only those that
apply).
General
5
4
3
2
1
N/A
Cardiac
5
4
3
2
1
N/A
Vascular
5
4
3
2
1
N/A
Peds
5
4
3
2
1
N/A
OB/GYN
5
4
3
2
1
N/A
Thoracic
5
4
3
2
1
N/A
Regional
5
4
3
2
1
N/A
Neuro
5
4
3
2
1
N/A
Trauma
5
4
3
2
1
N/A
ENT
5
4
3
2
1
N/A
H. Prepared me with the skills to perform patient assessment.
5
4
3
2
1
N/A
I.
Prepared me to perform invasive line procedures.
5
4
3
2
1
N/A
J.
Prepared me to perform difficult airway procedures.
5
4
3
2
1
N/A
Comments:
2
INSTRUCTIONS: Consider each item separately and rate each item independently of all others. Circle the rating
that indicates the extent to which you agree with each statement. Please do not skip any rating. If you do not know
about a particular area, please circle N/A.
5=Strongly Agree
4 =Generally Agree
3 =Neutral (acceptable)
2 =Generally Disagree
1 =Strongly Disagree N/A =Not Applicable
III. BEHAVORAL SKILLS (Affective Domain)
THE PROGRAM:
A. Prepared me to communicate effectively within a
healthcare setting.
5
4
3
2
1
N/A
B. Prepared me to conduct myself in an ethical and
professional manner.
5
4
3
2
1
N/A
C. Prepared me to manage my time efficiently while
functioning in a healthcare setting.
5
4
3
2
1
N/A
Comments:
IV. GENERAL INFORMATION (Check yes or no)
A. I have actively pursued attaining AA credentials.
B. I am a member of a national AA professional association.
C. I actively participate in continuing education activities.
Comments:
V. OVERALL RATING of the program:
Please rate and comment on the OVERALL quality of your preparation as an ENTRY-LEVEL Anesthetist.
5 = Excellent
4 = Very Good
3 = Good
2 = Fair
1 = Poor
Comments:
3
VI.
ADDITIONAL COMMENTS
Based on your work experience, please identify two or three strengths of the program.
Based on your work experience, please make two or three suggestions to further strengthen the
program.
What qualities/skills (if any) were expected of you upon employment, that were not included in the
program?
Please provide comments and suggestions that would help to better prepare future graduates.
Thank You!
Date:
4
EMPLOYER SURVEY
The primary goal of an Anesthesiologist Assistant Education program is to prepare the graduate to function as a competent
ENTRY-LEVEL Anesthetist. This survey is designed to help the program faculty determine the strengths and areas for
improvement for our program. All data will be kept confidential and will be used for program evaluation purposes only.
We request that this survey be completed by the graduate’s immediate supervisor.
BACKGROUND INFORMATION:
Name of Graduate:
Length of employment at time of evaluation:
years and
months.
INSTRUCTIONS: Consider each item separately and rate each item independently of all others. Circle the rating
that indicates the extent to which you agree with each statement. Please do not skip any rating. If you do not know
about a particular area, please circle N/A.
5=Strongly Agree
4 =Generally Agree
3 =Neutral (acceptable)
2 =Generally Disagree
1 =Strongly Disagree N/A =Not Applicable
I. KNOWLEDGE BASE (Cognitive Domain)
THE GRADUATE:
A. Has the anesthesia knowledge necessary
to function in a healthcare setting.
5
4
3
2
1
N/A
B. Has the general medical knowledge necessary
to function in a healthcare setting.
5
4
3
2
1
N/A
C. Is able to collect data from charts and patients.
5
4
3
2
1
N/A
D. Is able to interpret patient data.
5
4
3
2
1
N/A
E. Is able to perform appropriate anesthetic and/or
invasive line procedures.
5
4
3
2
1
N/A
5
4
3
2
1
N/A
F.
Demonstrates use of sound judgment while functioning
in a healthcare setting.
Comments:
5
INSTRUCTIONS: Consider each item separately and rate each item independently of all others. Circle the rating
that indicates the extent to which you agree with each statement. Please do not skip any rating. If you do not know
about a particular area, please circle N/A.
5=Strongly Agree
4 =Generally Agree
3 =Neutral (acceptable)
2 =Generally Disagree
1 =Strongly Disagree N/A =Not Applicable
II. CLINICAL PROFICIENCY (Psychomotor Domain)
THE GRADUATE:
G. Effectively performs a broad range of clinical skills.
5
4
3
2
1
N/A
H. Possesses the skills to perform patient assessment.
5
4
3
2
1
N/A
I.
5
4
3
2
1
N/A
K. Communicates effectively within a healthcare setting.
5
4
3
2
1
N/A
L. Conducts himself/herself in an ethical and
professional manner.
5
4
3
2
1
N/A
M. Functions effectively as a member of a healthcare team.
5
4
3
2
1
N/A
N. Accepts supervision and works effectively with
supervisory personnel.
5
4
3
2
1
N/A
O. Is self-directed and responsible for his/her actions.
5
4
3
2
1
N/A
Is able to perform current anesthetic procedures.
Comments:
III. BEHAVORAL SKILLS (Affective Domain)
THE GRADUATE:
Comments:
6
IV.
OVERALL RATING:
Please rate and comment on the OVERALL quality of this program’s graduate.
5 = Excellent
4 = Very Good
3 = Good
2 = Fair
1 = Poor
Comments:
VI.
ADDITIONAL COMMENTS
What qualities or skills (if any) did you expect of the graduate upon employment that he/she did not possess?
Please provide comments and suggestions that would help this program to better prepare future graduates.
What are strengths of the graduates of this program?
If given the opportunity, would you hire another graduate from this program?
Rater Signature
Date
 YES
 NO
Title
7
GRADUATE & EMPLOYER FEEDBACK MATRIX
(TO BE COMPLETED FOLLOWING EACH GRADUATING CLASS)
#
1
EVALUATION
INSTRUMENT
GRADUATE
SURVEY
LEARNING DOMAIN
DATE(S)OF
MEASUREMENT
RESULTS - ANALYSIS
(COMPOSITE SUMMARY)
ACTION PLAN
Cognitive Domain
2
GRADUATE
SURVEY
Psychomotor Domain
3
GRADUATE
SURVEY
Affective Domain
1
EMPLOYER
SURVEY
Cognitive Domain
2
EMPLOYER
SURVEY
Psychomotor Domain
3
EMPLOYER
SURVEY
Affective Domain
8
"SAMPLE" GRADUATE & EMPLOYER FEEDBACK MATRIX
(TO BE COMPLETED FOLLOWING EACH GRADUATING CLASS)
#
1
EVALUATION
INSTRUMENT
GRADUATE
SURVEY
LEARNING DOMAIN
Cognitive Domain
To assess the overall
knowledge base of
program graduates.
Psychomotor Domain
To assess the overall
clinical performance
(proficiency) of program
graduates.
Affective Domain
To assess the overall
interpersonal
communication skills of
program graduates.
Cognitive Domain
To assess the overall
knowledge base of
program graduates.
DATE(S)OF
MEASUREMENT
Six months after
graduation.
Month/Year
2
GRADUATE
SURVEY
Six months after
graduation.
Month/Year
3
GRADUATE
SURVEY
1
EMPLOYER
SURVEY
2
EMPLOYER
SURVEY
Psychomotor Domain
To assess the overall
clinical performance
(proficiency) of program
graduates.
Six months after
graduation.
Month/Year
3
EMPLOYER
SURVEY
Affective Domain
To assess the overall
interpersonal
communication skills of
program graduates.
Six months after
graduation.
Month/Year
Six months after
graduation.
Month/Year
Six months after
graduation.
Month/Year
RESULTS - ANALYSIS
(COMPOSITE SUMMARY)
All graduates surveyed rated
their overall knowledge base
at or above the "cut score" of 3
on a 5 point Likert scale.
All graduates surveyed rated
their overall clinical
performance at or above the
"cut score" of 3 on a 5 point
Likert scale.
All graduates surveyed rated
their overall inter-personal
communication skills at or
above the "cut score" of 3 on a
5 point Likert scale.
All employers surveyed rated
the graduate's overall
knowledge base at or above
the "cut score" of 3 on a 5
point Likert scale.
Employers surveyed rated the
graduate's overall clinical
performance at 2.5 which is
below the "cut score" of 3 on a
5 point Likert scale
All employers surveyed rated
the graduate's overall
interpersonal communication
skills at or above the "cut
score" of 3 on a 5 point Likert
scale.
ACTION PLAN
Continue to monitor.
Continue to monitor.
Continue to monitor.
Continue to monitor.
The program is evaluating the amount of
hours devoted to anesthetic time. The
program is considering increasing the
number of clinical clock hours within the
program to improve the student's scanning
techniques.
Continue to monitor.
9