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CITI Basic Course Participant Evaluation

* Questions marked with an asterisk require a response

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* 1. Please indicate your professional status.

Physician

Psychologist

Nurse

Other

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* 2. Was this learning activity fair, balanced, and free of commercial bias?

Yes

No

If not, please provide explanation below.

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* 3. Was the format appropriate for this learning activity?

Yes

No

If not, please provide an explanation below.

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* 4. At the conclusion of this activity I am able to:

	Yes	No
Incorporate the federal regulations and policies, which protect human subjects into the research environment.	Incorporate the federal regulations and policies, which protect human subjects into the research environment. Yes	Incorporate the federal regulations and policies, which protect human subjects into the research environment. No
Improve human subjects research study design through greater attention to potential risks and harms associated with human subject participation in research.	Improve human subjects research study design through greater attention to potential risks and harms associated with human subject participation in research. Yes	Improve human subjects research study design through greater attention to potential risks and harms associated with human subject participation in research. No
Evaluate the Belmont Report as the foundation of US policies toward human subjects research.	Evaluate the Belmont Report as the foundation of US policies toward human subjects research. Yes	Evaluate the Belmont Report as the foundation of US policies toward human subjects research. No
Identify how risks and potential harms associated with participation in social and behavioral human subjects research are less predictable with respect to occurrence, effect and long term outcome.	Identify how risks and potential harms associated with participation in social and behavioral human subjects research are less predictable with respect to occurrence, effect and long term outcome. Yes	Identify how risks and potential harms associated with participation in social and behavioral human subjects research are less predictable with respect to occurrence, effect and long term outcome. No

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* 5. Participation in this activity has:

	Strongly Disgaree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
Increased my knowledge	Increased my knowledge Strongly Disgaree	Increased my knowledge Disagree	Increased my knowledge Neither Agree nor Disagree	Increased my knowledge Agree	Increased my knowledge Strongly Agree
Improved my competence (ability to perform)	Improved my competence (ability to perform) Strongly Disgaree	Improved my competence (ability to perform) Disagree	Improved my competence (ability to perform) Neither Agree nor Disagree	Improved my competence (ability to perform) Agree	Improved my competence (ability to perform) Strongly Agree
Enhanced my performance (will practice regularly in the workplace)	Enhanced my performance (will practice regularly in the workplace) Strongly Disgaree	Enhanced my performance (will practice regularly in the workplace) Disagree	Enhanced my performance (will practice regularly in the workplace) Neither Agree nor Disagree	Enhanced my performance (will practice regularly in the workplace) Agree	Enhanced my performance (will practice regularly in the workplace) Strongly Agree

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* 6. This educational activity has contributed to my professional effectiveness and has improved my ability to:

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
Treat/manage patients	Treat/manage patients Strongly Disagree	Treat/manage patients Disagree	Treat/manage patients Neither Agree nor Disagree	Treat/manage patients Agree	Treat/manage patients Strongly Agree
Communicate with patients	Communicate with patients Strongly Disagree	Communicate with patients Disagree	Communicate with patients Neither Agree nor Disagree	Communicate with patients Agree	Communicate with patients Strongly Agree
Manage my medical practice	Manage my medical practice Strongly Disagree	Manage my medical practice Disagree	Manage my medical practice Neither Agree nor Disagree	Manage my medical practice Agree	Manage my medical practice Strongly Agree

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* 7. Overall Quality

	Poor	Fair	Average	Good	Excellent
Please provide an overall quality rating for this activity.	Please provide an overall quality rating for this activity. Poor	Please provide an overall quality rating for this activity. Fair	Please provide an overall quality rating for this activity. Average	Please provide an overall quality rating for this activity. Good	Please provide an overall quality rating for this activity. Excellent

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* 8. I intend to make the following changes as a result of participating in this learning experience:

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* 9. Comments/Suggestions