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American Heart Association Emergency Cardiovascular Care Program Instructor Monitor Form Name of Instructor Type of Instructor HS BLS ACLS ACLS-EP PALS Instructor s Primary TC for This Discipline Reason for Monitoring Initial Recognition TC Sponsoring Instructor Course Instructor Course Date Renewal Instructor Card Expiration Date Remediation for repeat monitoring as needed if previous monitoring is unsuccessful Previous Monitoring Date Name of Reviewer Reviewer s status check all that apply TCF BLS IT Course Director Lead Instructor Monitoring Date Name of Course Taught ie BLS Healthcare Provider Renewal Course Teaching was monitored during the following part s of course Teaching/Skills Stations Evaluation/Skills Stations Instructions Check appropriate box E Excellent S Satisfactory NI Needs Improvement NA Not Applicable for all criteria that apply to the monitoring process. Instructor teaching and student evaluation skills are to be monitored* Please complete all areas. Comment on all areas indicated as Needs Improvement. E Teaching Effectiveness Organizes physical set-up to facilitate learning by students Introduces objectives/outline Covers core content following outline consistent with AHA guidelines Summarizes key information Demonstrates mastery of course content/ability to respond to student questions Demonstrates willingness and ability to demonstrate skills when applicable Allows adequate time for skills practice Uses interactive teaching style/encourages student participation Manages time effectively begins/ends on time avoids digression from key points S NI NA Comments Provides effective and ongoing feedback to students Demonstrates professionalism appropriate attire use of terminology etc Evaluation Effectiveness Uses performance checklists as available Evaluates fairly using current AHA guidelines and materials Provides or recommends appropriate remediation Materials/Equipment Uses equipment that is clean and in good working order Uses appropriate standard universal precautions whenever applicable Uses current AHA materials video tool kit etc to deliver content All students are using appropriate AHA textbook Refers to AHA textbook during teaching and/or evaluation feedback troubleshoot audiovisual equipment Signatures/Recommendations should send completed form to Instructor s primary TC for discipline monitored* Reviewer s Recommendations/Comments Do you recommend new/renewal of Instructor status for this Instructor Candidate/Instructor Yes No If no please summarize your rationale and provide recommendations for remediation please attach additional comments as needed. Signature of Reviewer Date Instructor s Comments please attach additional comments as needed Signature of Instructor Date April 2004 Page 2. Instructor teaching and student evaluation skills are to be monitored* Please complete all areas. Comment on all areas indicated as Needs Improvement. E Teaching Effectiveness Organizes physical set-up to facilitate learning by students Introduces objectives/outline Covers core content following outline consistent with AHA guidelines Summarizes key information Demonstrates mastery of course content/ability to respond to student questions Demonstrates willingness and ability to demonstrate skills when applicable Allows adequate time for skills practice Uses interactive teaching style/encourages student participation Manages time effectively begins/ends on time avoids digression from key points S NI NA Comments Provides effective and ongoing feedback to students Demonstrates professionalism appropriate attire use of terminology etc Evaluation Effectiveness Uses performance checklists as available Evaluates fairly using current AHA guidelines and materials Provides or recommends appropriate remediation Materials/Equipment Uses equipment that is clean and in good working order Uses appropriate standard universal precautions whenever applicable Uses current AHA materials video tool kit etc to deliver content All students are using appropriate AHA textbook Refers to AHA textbook during teaching and/or evaluation feedback troubleshoot audiovisual equipment Signatures/Recommendations should send completed form to Instructor s primary TC for discipline monitored* Reviewer s Recommendations/Comments Do you recommend new/renewal of Instructor status for this Instructor Candidate/Instructor Yes No If no please summarize your rationale and provide recommendations for remediation please attach additional comments as needed.

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