1 Start 2 Complete

Please complete each of the following questions

What is your current role? *

SelectPhysicianPhysician AssistantNurse PractitionerPharmacistNurseOther

What is your current role? Other

What is your practice setting? *

SelectUniversity/Medical SchoolHospital/ClinicPrivate/Group PracticeState/Local GovernmentPharmaceutical/Biotech IndustryFederal GovernmentCorrectional FacilitiesMilitaryOther

What is your practice setting? Other

What is your gender? *

SelectFemaleMalePrefer not to answerPrefer to self describe

What is your gender? Prefer to self describe

Is Infectious disease your primary specialty? *

Yes

No

If no, please specify

Is Infectious disease your primary specialty? If no, please specify

Years in practice (post training)? *

1 - 5

5- 10

10- 15

> 15

Other

Years in practice (post training)? Other

I have previously learned about antimicrobial stewardship *

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

For the following statements, indicate how confident you are in your ability to: *

	Not at all	Somewhat	Moderately	Very	Extremely
Educate other healthcare providers on the importance of antimicrobial stewardship in the care of their individual patients	Educate other healthcare providers on the importance of antimicrobial stewardship in the care of their individual patients - Not at all	Educate other healthcare providers on the importance of antimicrobial stewardship in the care of their individual patients - Somewhat	Educate other healthcare providers on the importance of antimicrobial stewardship in the care of their individual patients - Moderately	Educate other healthcare providers on the importance of antimicrobial stewardship in the care of their individual patients - Very	Educate other healthcare providers on the importance of antimicrobial stewardship in the care of their individual patients - Extremely
Educate other healthcare providers on the importance of antimicrobial stewardship in the community at large	Educate other healthcare providers on the importance of antimicrobial stewardship in the community at large - Not at all	Educate other healthcare providers on the importance of antimicrobial stewardship in the community at large - Somewhat	Educate other healthcare providers on the importance of antimicrobial stewardship in the community at large - Moderately	Educate other healthcare providers on the importance of antimicrobial stewardship in the community at large - Very	Educate other healthcare providers on the importance of antimicrobial stewardship in the community at large - Extremely
Model antimicrobial stewardship in your day-to-day care of patients in the inpatient setting	Model antimicrobial stewardship in your day-to-day care of patients in the inpatient setting - Not at all	Model antimicrobial stewardship in your day-to-day care of patients in the inpatient setting - Somewhat	Model antimicrobial stewardship in your day-to-day care of patients in the inpatient setting - Moderately	Model antimicrobial stewardship in your day-to-day care of patients in the inpatient setting - Very	Model antimicrobial stewardship in your day-to-day care of patients in the inpatient setting - Extremely
Model antimicrobial stewardship in your day-to-day care of patients in the outpatient setting	Model antimicrobial stewardship in your day-to-day care of patients in the outpatient setting - Not at all	Model antimicrobial stewardship in your day-to-day care of patients in the outpatient setting - Somewhat	Model antimicrobial stewardship in your day-to-day care of patients in the outpatient setting - Moderately	Model antimicrobial stewardship in your day-to-day care of patients in the outpatient setting - Very	Model antimicrobial stewardship in your day-to-day care of patients in the outpatient setting - Extremely
Determine when an infectious diseases consultation would be more appropriate than just an antimicrobial stewardship intervention over the phone	Determine when an infectious diseases consultation would be more appropriate than just an antimicrobial stewardship intervention over the phone - Not at all	Determine when an infectious diseases consultation would be more appropriate than just an antimicrobial stewardship intervention over the phone - Somewhat	Determine when an infectious diseases consultation would be more appropriate than just an antimicrobial stewardship intervention over the phone - Moderately	Determine when an infectious diseases consultation would be more appropriate than just an antimicrobial stewardship intervention over the phone - Very	Determine when an infectious diseases consultation would be more appropriate than just an antimicrobial stewardship intervention over the phone - Extremely
Use effective communication techniques to change the antimicrobial prescribing practices of other healthcare providers	Use effective communication techniques to change the antimicrobial prescribing practices of other healthcare providers - Not at all	Use effective communication techniques to change the antimicrobial prescribing practices of other healthcare providers - Somewhat	Use effective communication techniques to change the antimicrobial prescribing practices of other healthcare providers - Moderately	Use effective communication techniques to change the antimicrobial prescribing practices of other healthcare providers - Very	Use effective communication techniques to change the antimicrobial prescribing practices of other healthcare providers - Extremely
Identify the elements of an effective hospital-based antimicrobial stewardship program	Identify the elements of an effective hospital-based antimicrobial stewardship program - Not at all	Identify the elements of an effective hospital-based antimicrobial stewardship program - Somewhat	Identify the elements of an effective hospital-based antimicrobial stewardship program - Moderately	Identify the elements of an effective hospital-based antimicrobial stewardship program - Very	Identify the elements of an effective hospital-based antimicrobial stewardship program - Extremely
Identify the inter-professional collaborations necessary for an effective hospital-based antimicrobial stewardship program	Identify the inter-professional collaborations necessary for an effective hospital-based antimicrobial stewardship program - Not at all	Identify the inter-professional collaborations necessary for an effective hospital-based antimicrobial stewardship program - Somewhat	Identify the inter-professional collaborations necessary for an effective hospital-based antimicrobial stewardship program - Moderately	Identify the inter-professional collaborations necessary for an effective hospital-based antimicrobial stewardship program - Very	Identify the inter-professional collaborations necessary for an effective hospital-based antimicrobial stewardship program - Extremely
Describe the day-to-day activities of a leader in an antimicrobial stewardship program	Describe the day-to-day activities of a leader in an antimicrobial stewardship program - Not at all	Describe the day-to-day activities of a leader in an antimicrobial stewardship program - Somewhat	Describe the day-to-day activities of a leader in an antimicrobial stewardship program - Moderately	Describe the day-to-day activities of a leader in an antimicrobial stewardship program - Very	Describe the day-to-day activities of a leader in an antimicrobial stewardship program - Extremely
Identify the initial steps that the antimicrobial stewardship team would use to respond to an antibiotic shortage at your hospital	Identify the initial steps that the antimicrobial stewardship team would use to respond to an antibiotic shortage at your hospital - Not at all	Identify the initial steps that the antimicrobial stewardship team would use to respond to an antibiotic shortage at your hospital - Somewhat	Identify the initial steps that the antimicrobial stewardship team would use to respond to an antibiotic shortage at your hospital - Moderately	Identify the initial steps that the antimicrobial stewardship team would use to respond to an antibiotic shortage at your hospital - Very	Identify the initial steps that the antimicrobial stewardship team would use to respond to an antibiotic shortage at your hospital - Extremely

Additional Comments:

Leave this field blank