Quit Tobacco International Curriculum

Module Review and Feedback Form for Faculty

Module being reviewed: [Module: Tobacco & Reproductive Sytem]
Rating scale for each component of the module:
1 = agree strongly
2 = agree
3 = disagree
4 = disagree strongly
Module component Rating
Learning objecties:
! Understand the effect of smoking on the menstrual cycle and its
endocrine effects
! Understand the effect of tobacco on early pregnancy poor outcomes
! Understand the risk and mechanism of tobacco leading to intrauterine
growth retardation
! Understand the benefits of cessation on fetal growth and birth weight
outcomes
! Understand the impact of passive smoking on pregnancy outcomes
"hese learning objecties are important for students to master# 1 2 3 4
$omments:
Mini lecture !: [Tobacco effects on fertility] Rating
1# "he content of this mini lecture is important for students to learn#
2# "he spea%er&s notes are enough for a faculty 'ho is not e(pert to gie the
lecture#
3# "he lecture material appropriate to the academic leel e(pected for the
students
4# "he readings proided for the facilitator for reference
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
$omments:
Mini lecture ": [Tobacco effects on pregnancy] Rating
1# "he content of this mini lecture is important for students to learn#
2# "he spea%er&s notes are enough for a faculty 'ho is not e(pert to gie the
lecture#
1 2 3 4
1 2 3 4
3# "he lecture material appropriate to the academic leel e(pected for the
students
4# "he readings proided for the facilitator for reference
1 2 3 4
1 2 3 4
$omments:
Mini lecture #: [Second hand smoke and pregnancy] Rating
1# "he content of this mini lecture is important for students to learn#
2# "he spea%er&s notes are enough for a faculty 'ho is not e(pert to gie the
lecture#
3# "he lecture material is appropriate to the academic leel e(pected for the
students
4# "he readings proided for the facilitator for reference
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
$omments:
Sample e$amination %uetion [Tobacco & Reproductive Sytem] Rating
"he sample e(amination )uestions are appropriate to the academic leel
e(pected for the students#
"he sample )uestions 'ill be useful for an instructor to ealuate students#
1 2 3 4
1 2 3 4
$omments:
Fact &eet [Tobacco & Reproductive Sytem] Rating
1# "he content of this fact sheet is important for students to learn#
2# "he fact sheet is clear enough for the instructor to be able to ealuate student
s%ills#
3# "he facts are appropriate to the academic leel e(pected for the students
1 2 3 4
1 2 3 4
1 2 3 4
$omments:
Cae Scenario: [Tobacco & Reproductive Sytem]
1# "he content of this scenario is important for students to learn#
2# "he fact sheets for this scenario proide enough information to facilitate
student discussion#
1 2 3 4
1 2 3 4
$omments:
'ey Reource( Reference: Rating
1# "he reie' articles 'ill help an instructor 'ho is not e(pert in tobacco to
teach the content of this module#
1 2 3 4
$omments:
)eb*ite reource Rating
1# "hese resources 'ill help an instructor 'ho is not e(pert in tobacco to teach
the content of this module#
1 2 3 4
$omments:
Citation for mini lecture preentation Rating
1# "he citations are complete enough that an instructor could find the original
sources if necessary#
1 2 3 4
$omments:
+verall evaluation of t&e module Rating
1# "his module is a aluable resource to help instructors 'ho are not tobacco
e(perts to teach about tobacco cessation#
2# "his module 'ill help learn about tobacco cessation#
1 2 3 4
1 2 3 4
$omments:
*hould anything be added+