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TeamSTEPPS® Long-Term Care Version: Module 11

Teaching Feedback Form

Name: ___________________________ Date: ____________________________________

Performance Criteria	Rating			Comments
Performance Criteria	Accept- able	Unaccept- able	Not Applicable (N/A)	Comments
1. Introduced topic in terms of relevance to teamwork
2. Presented content with accuracy
3. Used examples from personal experience to optimize learner understanding of teamwork concept
4. Presented content with confidence (i.e., didn't rely on reading from text)
5. Avoided distracting mannerisms (i.e., words, gestures)
6. Coordinated slides with content
7. Promoted learner participation
8. Spoke clearly and audibly
9. Facilitated practical exercises with skill and purpose
10. Completed presentation within allotted time-frame

Evaluator: ______________________________________________________

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Internet Citation:

TeamSTEPPS Long-Term Care Version, Module 11. Teaching Feedback Form. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/teamsteppstools/longtermcare/module11/tchfeedbkform.htm