Please answer the following questions to help us determine this activity’s effectiveness in meeting the identified educational needs.We appreciate your participation in this activity and value your feedback. What is your area of speciality? 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 presentation in terms of how it 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 Speaker First Name, Last Name, Credentials Speaker First Name, Last Name, Credentials - 1 Speaker First Name, Last Name, Credentials - 2 Speaker First Name, Last Name, Credentials - 3 Speaker First Name, Last Name, Credentials - 4 Speaker First Name, Last Name, Credentials - 5 Speaker First Name, Last 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 activity: Before the activity: - 1 Before the activity: - 2 Before the activity: - 3 Before the activity: - 4 Before the activity: - 5 Before the activity: - 6 Before the activity: - 7 Before the activity: - 8 Before the activity: - 9 Before the activity: - 10 After the activity: After the activity: - 1 After the activity: - 2 After the activity: - 3 After the activity: - 4 After the activity: - 5 After the activity: - 6 After the activity: - 7 After the activity: - 8 After the activity: - 9 After the activity: - 10 Please respond regarding your ability to implement desired changes or skills as a result of your participation in this course. * YesNoUnsure Insert objective question 1 here Insert objective question 1 here - Yes Insert objective question 1 here - No Insert objective question 1 here - Unsure Insert objective question 2 here Insert objective question 2 here - Yes Insert objective question 2 here - No Insert objective question 2 here - Unsure Insert objective question 3 here Insert objective question 3 here - Yes Insert objective question 3 here - No Insert objective question 3 here - Unsure As a result of attending this activity 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 Program was free of commercial bias Program was free of commercial bias - Yes Program was free of commercial bias - No Program 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 _____ activity? Leave this field blank
