Self-Study Module - EM2025-3

Common Orthopedic Injuries

Created 9/16/2025 Expires 9/16/2028

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* 1. Learner Information
By signing this form, I attest that I have completed the participant requirements for this CME activity. Any patient/case information will be kept confidential.

First and Last Name and Credentials (i.e. Jane Doe, M.D.)

Date:

Number of AMA PRA Category 1 Credits™ Claiming (i.e., .50 or 1)

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* 2. Objectives were met for this activity, and this activity has enhanced my overall knowledge or abilities.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

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* 3. Please rate this conference

Excellent - The speaker, topic and presentation were superior. The presenter demonstrated substantive knowledge of the topic

Good - Speaker was knowledgeable, presentation was satisfactory.

Fair – Speaker and presentation were average.

Poor – Speaker and presentation were unsatisfactory.

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* 4. Was this activity engaging and/or interactive

Yes

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* 5. Are the written materials helpful, and will they be useful references in the future?

Yes

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* 6. This CE Activity….

	Met my learning needs	Was relevant to my current scope of practice	Contributed to my professional growth.	Helped me learn skills and concepts that will allow me to be effective and strategic in my practice	Allowed me to increase my connections with peers.	Provided me with new ideas and resources.
Select all that apply	Select all that apply Met my learning needs	Select all that apply Was relevant to my current scope of practice	Select all that apply Contributed to my professional growth.	Select all that apply Helped me learn skills and concepts that will allow me to be effective and strategic in my practice	Select all that apply Allowed me to increase my connections with peers.	Select all that apply Provided me with new ideas and resources.

Other (please specify)

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* 7. Identify any specific changes that you plan to implement in your professional practice as a result of information you obtained as an attendee of this CME activity:

	None - Retired from Practice	Patient Work-up	Treatment Plans	Patient Education
Select all that apply.	Select all that apply. None - Retired from Practice	Select all that apply. Patient Work-up	Select all that apply. Treatment Plans	Select all that apply. Patient Education

Other (please specify)

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* 8. This activity changed, enhanced, or improved my:

	Knowledge	Competency	Performance	Patient Outcomes	Communication skills	Practice-based systems	System-based practices
Select all that apply	Select all that apply Knowledge	Select all that apply Competency	Select all that apply Performance	Select all that apply Patient Outcomes	Select all that apply Communication skills	Select all that apply Practice-based systems	Select all that apply System-based practices

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* 9. Activity was free of commercial bias

Yes

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* 10. Activity was evidence-based

Yes

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* 11. What are the impediments to change?

	Cost	Insurance/reimbursement issues	Lack time to assess/counsel patients	Patient compliance issues	Lack of administrative support/resources	Lack of consensus of professional guidelines
Select all that apply.	Select all that apply. Cost	Select all that apply. Insurance/reimbursement issues	Select all that apply. Lack time to assess/counsel patients	Select all that apply. Patient compliance issues	Select all that apply. Lack of administrative support/resources	Select all that apply. Lack of consensus of professional guidelines

Other (please specify)

Self-Study Module - EM2025-3

Common Orthopedic Injuries

Question Title

* 1. Learner Information
By signing this form, I attest that I have completed the participant requirements for this CME activity. Any patient/case information will be kept confidential.

Question Title

* 2. Objectives were met for this activity, and this activity has enhanced my overall knowledge or abilities.

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* 3. Please rate this conference

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* 4. Was this activity engaging and/or interactive

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* 5. Are the written materials helpful, and will they be useful references in the future?

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* 6. This CE Activity….

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* 7. Identify any specific changes that you plan to implement in your professional practice as a result of information you obtained as an attendee of this CME activity:

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* 8. This activity changed, enhanced, or improved my:

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* 9. Activity was free of commercial bias

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* 10. Activity was evidence-based

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* 11. What are the impediments to change?

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* 12. What piece of information did you garner from this presentation and how could you utilize this information in your practice?

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* 13. Comments on this activity, or suggestions for CME topics.

Self-Study Module - EM2025-3

Common Orthopedic Injuries

Question Title

* 1. Learner InformationBy signing this form, I attest that I have completed the participant requirements for this CME activity. Any patient/case information will be kept confidential.

Question Title

* 2. Objectives were met for this activity, and this activity has enhanced my overall knowledge or abilities.

Question Title

* 3. Please rate this conference

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* 4. Was this activity engaging and/or interactive

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* 5. Are the written materials helpful, and will they be useful references in the future?

Question Title

* 6. This CE Activity….

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* 7. Identify any specific changes that you plan to implement in your professional practice as a result of information you obtained as an attendee of this CME activity:

Question Title

* 8. This activity changed, enhanced, or improved my:

Question Title

* 9. Activity was free of commercial bias

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* 10. Activity was evidence-based

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* 11. What are the impediments to change?

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* 12. What piece of information did you garner from this presentation and how could you utilize this information in your practice?

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* 13. Comments on this activity, or suggestions for CME topics.

* 1. Learner Information
By signing this form, I attest that I have completed the participant requirements for this CME activity. Any patient/case information will be kept confidential.