Teaching Feedback Form

TeamSTEPPS® Long-Term Care Version: Module 11

The Long-Term Care version of TeamSTEPPS adapts the core concepts of the TeamSTEPPS program to reflect the environment of nursing homes and other other long-term care settings such as assisted living and continuing care retirement communities. The examples, discussions, and exercises below are tailored to the long-term care environment.

Name: ___________________________   Date: ____________________________________

Performance Criteria Rating 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: ______________________________________________________


Page last reviewed November 2012
Page originally created November 2012
Internet Citation: Teaching Feedback Form. Content last reviewed November 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/teamstepps/longtermcare/module11/tchfeedbkfm.html