Please answer the following questions to help us determine this series effectiveness in meeting the identified educational needs.We appreciate your participation in this series and value your feedback. What is your area of specialty? e.g.: Family Medicine, Cardiology, Ob/Gyn, etc. How many years have you been in practice? -Years-0-56-1011-1516-2122-2728-3334+ Evaluate each presenter in terms of how they enhanced your knowledge and ability to apply new strategies and tools in your clinical practice. 1= Poor: Provided no new knowledge or strategies I can apply 2= Fair: Provided minimal new knowledge with limited strategies I can apply 3= Neutral: Reinforced current knowledge and strategies I currently apply 4= Good: Addressed gaps in knowledge and offered some strategies I will consider applying 5= Excellent: Addressed gaps in knowledge and offered strategies I will apply 12345Did not attend Name, Credentials Name, Credentials - 1 Name, Credentials - 2 Name, Credentials - 3 Name, Credentials - 4 Name, Credentials - 5 Name, Credentials - Did not attend Name, Credentials Name, Credentials - 1 Name, Credentials - 2 Name, Credentials - 3 Name, Credentials - 4 Name, Credentials - 5 Name, Credentials - Did not attend Provide individualized speaker comments or feedback Rate your ability to apply advances in ___ to your clinical practice: * 1 = Not at all able 10 = Extremely able 12345678910 Before the series: Before the series: - 1 Before the series: - 2 Before the series: - 3 Before the series: - 4 Before the series: - 5 Before the series: - 6 Before the series: - 7 Before the series: - 8 Before the series: - 9 Before the series: - 10 After the series: After the series: - 1 After the series: - 2 After the series: - 3 After the series: - 4 After the series: - 5 After the series: - 6 After the series: - 7 After the series: - 8 After the series: - 9 After the series: - 10 Please respond regarding your ability to implement desired changes or skills as a result of your participation in this session. * YesNoUnsure Insert objective question here Insert objective question here - Yes Insert objective question here - No Insert objective question here - Unsure Insert objective question here Insert objective question here - Yes Insert objective question here - No Insert objective question here - Unsure Insert objective question here Insert objective question here - Yes Insert objective question here - No Insert objective question here - Unsure As a result of attending this session what new strategies will you apply? * What barriers will prevent you from making any desired changes? Check all that apply. Cost Need for more training Lack of opportunity or clinical application Resource availability Time constraints Patient adherence Lack of consensus on professional guidelines No perceived barriers Other. Please explain: What barriers will prevent you from making any desired changes? Other. Please explain: Will you attempt to address any identified barriers? Yes No Unsure If no, please explain: Please respond to the following statements: YesNoUnsure Session was free of commercial bias Session was free of commercial bias - Yes Session was free of commercial bias - No Session was free of commercial bias - Unsure Appropriate disclosure of conflict of interest was made for each speaker, author and/or planner Appropriate disclosure of conflict of interest was made for each speaker, author and/or planner - Yes Appropriate disclosure of conflict of interest was made for each speaker, author and/or planner - No Appropriate disclosure of conflict of interest was made for each speaker, author and/or planner - Unsure Educational content covered was balanced and evidenced-based Educational content covered was balanced and evidenced-based - Yes Educational content covered was balanced and evidenced-based - No Educational content covered was balanced and evidenced-based - Unsure Information provided was relevant to your scope of practice Information provided was relevant to your scope of practice - Yes Information provided was relevant to your scope of practice - No Information provided was relevant to your scope of practice - Unsure Instructional methods used during this activity appropriate for the content and audience Instructional methods used during this activity appropriate for the content and audience - Yes Instructional methods used during this activity appropriate for the content and audience - No Instructional methods used during this activity appropriate for the content and audience - Unsure If you answered no to any of the above, please explain: Describe any clinical situation(s) that you find difficult to manage or resolve that you would like addressed in future educational activities: Do you have any general comments or suggestions regarding the Internal Medicine Department Education Meetings series? DO YOU WANT US TO SUBMIT YOUR COMPLETION OF THIS ACTIVITY TO ABIM?As an accredited CME provider we are able to partner with select ABMS boards to designate MOC/Continuing Certification Credits/Points. This activity is approved for the board listed below. You can click the hyperlink to check for your Board ID number:American Board of Internal Medicine (ABIM)It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABIM points. Please answer the following questions in order to proceed. Submit to ABIM? * By responding “Yes” I agree to allow the HealthPartners Office of CME to share my completion information with the American Board of Internal Medicine (ABIM) and the ACCME (Accreditation Council for Continuing Medical Education) so that points can be uploaded to my transcript. No, I am not an ABIM diplomate Yes, I want ABIM points and agree to have my completion info shared First and Last name: * Verify that your name below appears how it is registered with ABIM. Make changes if necessary. What is your month and day of birth? * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 What is your ABIM ID number? * American Board of Internal Medicine Please write a reflective statement on how you intend to change your practice based on the knowledge you gained from participating in this activity. Upon review and approval of your statement, your points will be submitted to the ABIM by the CME office.A good reflective statement includes:What you learned as a result of the activity & what will you do with new informationAny areas for improvementPlans for future learning or sustainabilityGeneric statements such as "Good conference. I learned a lot" or "This helps me treat my patients" will not be approved. Reflective Statement * Leave this field blank
