Evaluation: 6-2-2010 Grand Round Survey

Thank you for participating in our online Grand Round Series.

Our evaluation and certificate generation system is currently under construction. While we are working on improving the system, please use this temporary CME evaluation form. We will generate your certificate(s) based on your responses and mail the CME certificate to you via the US Postal Service. If you have any questions please email us at: mghsupport@reedmeded.com

Thank you.

Target Audience
Psychiatrists, Primary Car Physicians, Nurse Practitioners, and Physician Assistants

Accreditation
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of McLean Hospital, Massachusetts General Hospital Academy and Reed Medical Education. McLean Hospital is accredited by the ACCME to provide continuing medical education (CME) for physicians.

Credit Designation
McLean Hospital designates this continuing medical educational activity for a maximum of 1 AMA PRA Category 1 Credits(TM). Physicians should only claim credit commensurate with the extent of their participation in the activity.

Policy on Faculty and Provider Disclosure
It is the policy of McLean Hospital that faculty and providers disclose real or apparent conflicts of interest relating to the topics of this educational activity, and also disclose discussions of unlabeled/unapproved uses of drugs or devices during their presentation(s). McLean Hospital has established policies in place that will identify and resolve all conflicts of interest prior to this educational activity.

Supporters
Our evidence-based curriculum is supported by an educational grant from AstraZeneca, Bristol-Myers Squibb and Lilly.

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1. Demographic Information

Demographic Information Name:
Organization:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Email Address:
Phone Number:

2. Clinician Informaiton

Clinician Informaiton Degree (MD, PhD, RN, etc):
Profession (Psychiatrist, Psychologist, etc.):
Primary Specialty (Geriatric, ADHD, etc.):

3. Are you licensed in the US?

Are you licensed in the US? Yes

No

License #:

4. Length of time to complete this activity (maximum of 1 hour):

Length of time to complete this activity (maximum of 1 hour): Hours
Mins

5. Would you like to be part of the MGH Academy Clinical Community Follow-Up?

Would you like to be part of the MGH Academy Clinical Community Follow-Up? Yes

No

*
6. Program Evaluation: Please evaluate the effectiveness of this activity by indicating your choice on a scale of 1 to 5
(1 Strongly Disagree, 2 Disagree, 3 Moderately Agree, 4 Agree, 5 Strongly Agree)

	1	2	3	4	5
Understand the new approaches to anxious depression.	*Program Evaluation: Please evaluate the effectiveness of this activity by indicating your choice on a scale of 1 to 5 (1 Strongly Disagree, 2 Disagree, 3 Moderately Agree, 4 Agree, 5 Strongly Agree) Understand the new approaches to anxious depression. 1	Understand the new approaches to anxious depression. 2	Understand the new approaches to anxious depression. 3	Understand the new approaches to anxious depression. 4	Understand the new approaches to anxious depression. 5

7. Were the objectives listed above clearly stated?

Were the objectives listed above clearly stated? Yes

No

8. If so, were the objectives met?

If so, were the objectives met? Yes

No

*
9. Considering this program as a whole, please indicate whether you agree with the following statements on a scale of 1-5
(1 Strongly Disagree, 2 Disagree, 3 Moderately Agree, 4 Agree, 5 Strongly Agree)

	1	2	3	4	5
The program was appropriate for my level of education and experience	*Considering this program as a whole, please indicate whether you agree with the following statements on a scale of 1-5 (1 Strongly Disagree, 2 Disagree, 3 Moderately Agree, 4 Agree, 5 Strongly Agree) The program was appropriate for my level of education and experience 1	The program was appropriate for my level of education and experience 2	The program was appropriate for my level of education and experience 3	The program was appropriate for my level of education and experience 4	The program was appropriate for my level of education and experience 5
The information presented was relevant to my professional practice	The information presented was relevant to my professional practice 1	The information presented was relevant to my professional practice 2	The information presented was relevant to my professional practice 3	The information presented was relevant to my professional practice 4	The information presented was relevant to my professional practice 5
The information was current and accurate	The information was current and accurate 1	The information was current and accurate 2	The information was current and accurate 3	The information was current and accurate 4	The information was current and accurate 5
The overall quality of the program met my expectations	The overall quality of the program met my expectations 1	The overall quality of the program met my expectations 2	The overall quality of the program met my expectations 3	The overall quality of the program met my expectations 4	The overall quality of the program met my expectations 5
The information was presented in a fair, objective, balanced manner, free of bias and discussion of any commercial product or service	The information was presented in a fair, objective, balanced manner, free of bias and discussion of any commercial product or service 1	The information was presented in a fair, objective, balanced manner, free of bias and discussion of any commercial product or service 2	The information was presented in a fair, objective, balanced manner, free of bias and discussion of any commercial product or service 3	The information was presented in a fair, objective, balanced manner, free of bias and discussion of any commercial product or service 4	The information was presented in a fair, objective, balanced manner, free of bias and discussion of any commercial product or service 5

10. After viewing this webcast, would you change one or more aspects of the current treatment regimen you are currently using?

After viewing this webcast, would you change one or more aspects of the current treatment regimen you are currently using? Yes

No

11. If yes, what would you change?

If yes, what would you change?

Faculty Evaluation: Please evaluate the effectiveness of our faculty by indicating your choice on a scale of 1 to 5
(1 Strongly Disagree, 2 Disagree, 3 Moderately Agree, 4 Agree, 5 Strongly Agree)

*
12. Maurizio Fava, MD

	1	2	3	4	5
Quality and Clarity of Presentation	*Maurizio Fava, MD Quality and Clarity of Presentation 1	Quality and Clarity of Presentation 2	Quality and Clarity of Presentation 3	Quality and Clarity of Presentation 4	Quality and Clarity of Presentation 5
Knowledge of Topic	Knowledge of Topic 1	Knowledge of Topic 2	Knowledge of Topic 3	Knowledge of Topic 4	Knowledge of Topic 5
Relevance to Practice	Relevance to Practice 1	Relevance to Practice 2	Relevance to Practice 3	Relevance to Practice 4	Relevance to Practice 5

13. Any Comments or Suggestions:

Any Comments or Suggestions:

Evaluation: 6-2-2010 Grand Round

1. CME Evaluation Form

*1. Demographic Information