A. Your background:

1. Please indicate your discipline:
   1. dentistry
   2. medicine
   3. nursing
   4. pharmacy
   5. physical therapy
   6. social/behavioral sciences
   7. other (please list):
      
      
2. What is your status?
   1. faculty
   2. staff
   3. student
   4. resident
   5. other (please list):
      
      
3. How would you describe your experience with web-based learning activities?
   1. none/meager
   2. a fair amount
   3. I am a pro!
      
      
4. Which module(s) in the web-based core curriculum in geriatrics/gerontology did you review? Check all that apply:
   Module 1: Demography and Epidemiology
   Module 2: Biology and Physiology of Aging
   Module 3: Sociocultural and Psychology of Aging
   Module 4: Assessment of the Geriatric Patient
   Module 5: Health Care Policies

B. Please rate the following characteristics of the web modules:

1. Quality of the content (Is it appropriate for your level of students?)
   1. Poor
   2. Fair
   3. Average
   4. Good
   5. Excellent
      
      
2. Quality of instructional design (Is it designed to enhance learning?)
   1. Poor
   2. Fair
   3. Average
   4. Good
   5. Excellent
      
      
3. Instructions (How clear are instructions/assignments?)
   1. Poor
   2. Fair
   3. Average
   4. Good
   5. Excellent
      
      
4. Level of interactivity (How effectively is user input encouraged?)
   1. Poor
   2. Fair
   3. Average
   4. Good
   5. Excellent
      
      
5. Flexibility in navigation (How well are users able to maneuver their way through the program?)
   1. Poor
   2. Fair
   3. Average
   4. Good
   5. Excellent
      
      
6. Motivational components (How well does program engage user through novelty, game elements, testing, interesting content?)
   1. Poor
   2. Fair
   3. Average
   4. Good
   5. Excellent
      
      
7. Use of media (How effectively are graphics, animation, etc. employed?)
   1. Poor
   2. Fair
   3. Average
   4. Good
   5. Excellent
      
      
8. Evaluation (How effective are the internal quizzes, post-test, etc.?)
   1. Poor
   2. Fair
   3. Average
   4. Good
   5. Excellent
      
      
9. Aesthetics (How attractive and appealing is the structure/layout of the screen?)
   1. Poor
   2. Fair
   3. Average
   4. Good
   5. Excellent
      
      
10. Tone (How appropriate is the tone of the program for the level of the audience? Does it avoid sounding trite, condescending, pedantic, etc.?)
    1. Poor
    2. Fair
    3. Average
    4. Good
    5. Excellent

C. Please answer the following questions about your overall reactions to the modules:

1. Please rate your overall reactions to the program (where "1" represents the low end of each scale and "5" represents the high end):
   
   

   a) Terrible	(to)	Wonderful
   1   2	3	4   5

   b) Frustrating	(to)	Satisfying
   1   2	3	4   5

   c) Dull	(to)	Stimulating
   1   2	3	4   5

   d) Difficult	(to)	Easy
   1   2	3	4   5

   e) Rigid	(to)	Flexible
   1   2	3	4   5

   f) Confusing	(to)	Clear
   1   2	3	4   5

    

2. Do you think these web modules are a useful tool for teaching gerontology/geriatrics to health professions students?
   
   Yes     No
   
   
   
   1. Why or why not?
      
      
      

   2. If so, what level students are they appropriate for?
      

   3. What courses will the modules complement/fit into best? Please explain.
      

    

3. List 3 things that you learned in these modules that were new to you:

    

4. Any other comments? Anything else you’d like to tell us?
   

5. Optional
   1. Name:
      
      
      
   2. Institution/Agency/Organization:
      
      
      
   3. Mailing Address:
      
      
      
   4. Phone Number:
      
      
      
   5. Email Address: