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MPS Request
The Pediatrics Academy
Mobile Pediatric Simulation
Request course or workshop
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First Name
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Family Name
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Phone
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Country
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email
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Work place
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Choose
Simulation Center
Simulation Lab
University Hospital
Educational institute
Governmental Hospital
Private Hospital
Primary Care
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Educational Level
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Expert medical educator
University faculty
Experienced Pediatricians
Novices / Beginner
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Learning group
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10 learners is the minimum
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10-20
20-30
30-40
40-50
More than 50
Learners level
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Undergraduate
Postgraduate
Seniors
Faculties
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Speciality
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Pediatrics only
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Pediatric Sub-speciality
General pediatrics
Neonatology
PICU
Pediatric Emergency
Pediatric Primary Care
Pediatric Medical Students
Pediatric Nurses
Other pediatrics health professionals
Others
How do you hear about MPS Workshop
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What are your objectives from this course or workshop
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Please, list at least 3 objectives
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Details of your activity
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Details of your resources
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If you have a simulation lab, class, AV facilities, manikins, .... please specify
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