Quit Tobacco International CurriculumModule Review and Feedback Form for Faculty

Module being reviewed: [Module: Tobacco & Reproductive System]

Rating scale for each component of the module:1 = agree strongly2 = agree3 = disagree 4 = disagree strongly

Module component RatingLearning objectives:

• 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

These learning objectives are important for students to master. 1 2 3 4Comments:

Mini lecture 1: [Tobacco effects on fertility] Rating1. The content of this mini lecture is important for students to learn.

2. The speaker’s notes are enough for a faculty who is not expert to give the lecture.

3. The lecture material appropriate to the academic level expected for the students

4. The readings provided for the facilitator for reference

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

Comments:

Mini lecture 2: [Tobacco effects on pregnancy] Rating1. The content of this mini lecture is important for students to learn.

2. The speaker’s notes are enough for a faculty who is not expert to give the lecture.

1 2 3 4

1 2 3 4

3. The lecture material appropriate to the academic level expected for the students

4. The readings provided for the facilitator for reference

1 2 3 4

1 2 3 4

Comments:

Mini lecture 3: [Second hand smoke and pregnancy] Rating1. The content of this mini lecture is important for students to learn.

2. The speaker’s notes are enough for a faculty who is not expert to give the lecture.

3. The lecture material is appropriate to the academic level expected for the students

4. The readings provided for the facilitator for reference

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

Comments:

Sample examination questions [Tobacco & Reproductive System] RatingThe sample examination questions are appropriate to the academic level expected for the students.

The sample questions will be useful for an instructor to evaluate students.

1 2 3 4

1 2 3 4

Comments:

Fact sheets [Tobacco & Reproductive System] Rating1. The content of this fact sheet is important for students to learn.

2. The fact sheet is clear enough for the instructor to be able to evaluate student skills.

3. The facts are appropriate to the academic level expected for the students

1 2 3 4

1 2 3 4

1 2 3 4Comments:

Case Scenario: [Tobacco & Reproductive System] 1. The content of this scenario is important for students to learn.

2. The fact sheets for this scenario provide enough information to facilitate student discussion.

1 2 3 4

1 2 3 4

Comments:

Key Resources/ References: Rating1. The review articles will help an instructor who is not expert in tobacco to teach the content of this module.

1 2 3 4

Comments:

Web-site resources Rating1. These resources will help an instructor who is not expert in tobacco to teach the content of this module.

1 2 3 4

Comments:

Citations for mini lecture presentations Rating1. The citations are complete enough that an instructor could find the original sources if necessary.

1 2 3 4

Comments:

Overall evaluation of the module Rating1. This module is a valuable resource to help instructors who are not tobacco experts to teach about tobacco cessation.

2. This module will help learn about tobacco cessation.

1 2 3 4

1 2 3 4Comments:

Should anything be added?