myQIportal Registration Form

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Thank you for your interest in myQIportal - Physical Abuse. This quality improvement project is approved by the American Academy of Pediatrics (AAP), Section on Child Abuse and Neglect, for American Board of Pediatrics (ABP) Maintenance of Certification (MOC) Part 4 credit for Performance in Practice. Twenty-five Part 4 credits are available for completion. For more information on ABP certified quality improvement projects and MOC 4 credit requirements, visit www.abp.org. The intent of the project is to improve documentation and diagnostic accuracy of child physical abuse evaluations.

Please complete this survey so that we may enroll you. Your answers will be used to determine your eligibility to participate. Your answers also may be used for quality improvement assessment; if so, your identity will remain anonymous. This survey should take no more than 10 minutes to complete.

This registration form should only be completed by the medical professional intending to use this program.

Program Conditions

In order to participate in myQIportal, you will need to capture high quality photo documentation of the physical findings and later forward those images to the myQIportal website electronically. Prints or scanned images will not be accepted. Are you able to capture, store and electronically send the files obtained from your examinations?

YesNo

In order to participate in myQIportal, you will need to have/create an account on Box.com or download the Box application. Are you able to meet that requirement?

YesNo

Unfortunately, unless you are able to meet the above requirements of the program, you will not be able to participate.

Please exit from this registration form. Do not click Submit.

We invite you to check out other programming at

www.mrcac.org/medical-academy.

Experience and Background

Please select the highest professional degree you have obtained.

Associate DegreeBachelor's DegreeMaster's DegreeDoctorate Degree

Credentials:

Please enter your ABP number.

In what year did you begin providing medical care/evaluations for victims of suspected child abuse?

Please indicate how many patients you see in a given month for evaluation of suspected child abuse.

<5 patients/month5-10 patients/month11-15 patients/month>15 patients/month

How competent are you in the following skills?

	Not competent	Somewhat competent	Competent	Very competent
Conducting physical examinations
Conducting genital exams
Interpreting medical findings
Documenting medical findings in writing
Photo documenting (colposcopy, digital camera) medical findings
Communicating evaluation findings to others
Collaborating with the multidisciplinary team

How much do you agree with the following statements?

	Do not agree	Somewhat agree	Mostly agree	Agree
My needs for mentorship are being met.
I desire more collegiality/community with other medical providers who work in child abuse.
I want additional opportunities to teach/share knowledge.
I am resilient enough to continue this work (able to adapt to change and tendency to bounce back after hardship).

What is the single most difficult issue that you encounter in providing medical evaluations for child abuse?

What other challenges do you encounter in providing medical evaluations for child abuse?

I agree to allow the Midwest Regional Children’s Advocacy Center (MRCAC) to utilize my demographic information, including, but not limited to: credentials/licensure, enrollment in other MRCAC program offerings, pre- and post-test results, evaluation results and course completion results. This information will be utilized to determine efficacy in the course offerings and whether the courses are meeting their desired outcomes as well as assist in creating future programming. No personal identifying information will be utilized in the data analysis.

YesNo

Photodocumentation

Do you currently use any of the following equipment to obtain photodocumentation for child sexual abuse exams? Check all that apply.

Other equipment:

After you click on Submit below, you will need to click on the PayPal button to pay for your subscription. Your registration will not be considered final until payment is received.

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myQIportal Registration Form - Physical Abuse

Experience and Background

Photodocumentation