| Demographics |
| 1. Please indicate your gender. |
| Male |
| Female |
| Prefer not to identify |
| Other. Please specify: |
| 2. What's your current level of training? |
| Medical School 1 (PreClerkship) |
| Medical School 2 (PreClerkship) |
| Medical School 3 (Clinical Clerk) |
| Medical School 4 (Clinical Clerk) |
| Residency 1 |
| Residency 2 |
| Residency 3 |
| Residency 4 |
| Residency 5 |
| Fellowship |
| 3. Which specialty are you training in? (Indicate Medical Student if in preclerkship.) |
| Medical Student |
| Anesthesiology |
| Emergency Medicine |
| Family Medicine |
| General Surgery |
| Internal Medicine |
| Neurology |
| Obstetrics & Gynecology |
| Ophthalmology |
| Orthopedic Surgery |
| Otolaryngology |
| Pediatrics |
| Plastic Surgery |
| Psychiatry |
| Urology |
| 4. Which medical school did you attend? |
| McMaster University |
| Northern Ontario School of Medicine |
| University of Ottawa |
| Queen's University |
| University of Toronto |
| Western University |
| Out of Province: |
| International: |
| Needlestick Handling Training |
| 5. How did you feel about your needle handling safety training during your rotations at TEGH? |
| Not applicable |
| Didn't get any training |
| Not enough training |
| Just enough training |
| Too much training |
| 6. If you got training, was it offered in the form of (select all that apply): |
| Lectures |
| E-modules |
| Readings |
| On-the-spot |
| Other. Please specify: |
| 7. When do you think will be the best opportunity to introduce needle and sharp instruments handling? |
| Medical School 1 (PreClerkship) |
| Medical School 2 (PreClerkship) |
| Medical School 3 (Clinical Clerk) |
| Medical School 4 (Clinical Clerk) |
| Residency 1 |
| Residency 2 |
| Residency 3 or beyond |
| Other. Please specify: |
| Characteristics of Needlestick Injuries |
| 8. To the best of your ability, please indicate how many times you've experienced a needlestick injury in each period of training at TEGH. If “0” is inputted for all three choices, please go to the end of the survey and click “Submit”. |
| PreClerkship: |
| Clerkship: |
| Residency: |
| 9. How many times were you injured during each rotation at TEGH? (Leave fields blank if 0.) |
| Medical Student: |
| Anesthesiology: |
| Emergency Medicine: |
| Family Medicine: |
| General Surgery: |
| Internal Medicine: |
| Neurology: |
| Obstetrics & Gynaecology: |
| Ophthalmology: |
| Orthopedic Surgery: |
| Otolaryngology: |
| Pediatrics: |
| Plastic Surgery: |
| Psychiatry: |
| Urology: |
| 10. Please indicate the number of times you've been injured at TEGH by each instrument. (Leave field blank if 0.) |
| Solid Needle: |
| Cauterizer: |
| Hollow-Bore Needle: |
| Scalpel: |
| Other: |
| 11. How many times have you been injured while performing each procedure at TEGH? (Leave field blank if 0.) |
| Suturing: |
| Assisting: |
| Injecting: |
| Cleaning up: |
| Venipuncture: |
| Arterial puncture: |
| Passing needle: |
| Recapping needle: |
| Other: |
| 12. How many times have you been injured by each healthcare worker at TEGH? (Leave field blank if 0.) |
| Self: |
| Resident: |
| Staff: |
| Nurse: |
| Medical student: |
| Post-exposure actions |
| 13. What immediate action(s) did you take when the most recent needlestick injury occurred at TEGH? Select all that apply. |
| Continued working |
| Reported to someone |
| Washed wound |
| Were encouraged by witness to seek help |
| Consented patient to draw blood |
| Had patient's blood tested |
| Had own blood tested |
| 14. Who did you report to when the most recent needlestick injury occurred at TEGH? Select all that apply. |
| Didn't report to anybody |
| Colleague |
| Staff |
| Emergency Department |
| Occupational Health |
| Other: |
| 15. If you didn't report to TEGH Occupational Health, why not? (Skip if you reported to Occupational Health.) |
| Office was closed |
| Didn't think it was a big deal |
| Was told by staff/colleague that it wasn't a big deal |
| Stigma of having had a needlestick injury |
| Takes too much time |
| Didn't want to know results |
| 16. Did you take any HIV and/or hepatitis C prophylaxis when the most recent needlestick injury occurred at TEGH? |
| Yes |
| No. Please indicate why not: |
