AGEC Demographics Survey

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* 1. Your contact info:

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* 2. Which certificate(s) are you seeking Continuing Education Credit for this webinar? (Select all that apply)

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* 3. Gender (Select one)

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* 4. Age Range (Select one)

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* 5. Ethnicity (Select one)

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* 6. Race (Select one)

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* 7. PHARMACISTS ONLY

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* 8. Do you work in a primary care setting? (Select one)

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* 9. Do you work in a rural community? (Select one)

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* 10. Do you work in a Medically Underserved Community (MUC)? (Select one)

UAMS OCE Evaluation

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* 11. Are you a UAMS Employee? (Select one)

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* 12. Are you a member of a health care team? (Select one)

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* 13. Practice type: (Select one)

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* 14. Practice setting: (Select one)

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* 15. Please rate the impact of the following objectives
          As a result of attending this activity, I am better able to:'

  Strongly Agree Agree Neutral Disagree Strongly Disagree
Review current immunization recommendations for patients based on age and disease state
Recognize changes in vaccine-related recommendations and evaluate the changes in practice
Revise techniques highlighting the importance of strong vaccine recommendations

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* 16. As a result of attending this activity:

  Strongly Agree Agree Neutral Disagree Strongly Disagree Not Applicable
I intend to apply the knowledge and/or skills I have acquired from this activity to my work when in a team environment.
I am better able to collaborate with a multidisciplinary team.
I am better able to communicate with other members of a multidisciplinary team as a result of what I learned in this activity.
I am better able to discuss how teamwork can contribute to continuous and reliable patient care.

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* 17. Please rate the projected impact of this activity on your knowledge, competence, performance, and patient outcomes:
Competence is defined as the ability to apply knowledge, skills, and judgment in practice (knowing how to do something).

  Yes No No change
This activity increased my knowledge.
This activity increased my competence.
This activity will improve my performance.
This activity will improve my patient outcomes.

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* 18. Do you feel the activity was scientifically sound and free of commercial bias or influence? (Select one)

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* 19. Please identify how you will change your practice as a result of attending this activity (Select all that apply)

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* 20. Please indicate any barriers you perceive in implementing these changes. (Select all that apply)

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* 21. Will you attempt to address these barriers in order to implement changes in your competence, performance, and/or patients’ outcomes? (Select one)

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* 22. For the content presented, how might the format of this activity be improved?(Select all that apply)

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* 23. Overall, were the speakers knowledgeable regarding the content? (Select one)

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* 24. Overall, were the presentations balanced, objective, and scientifically rigorous?
(Select one)

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* 25. For future educational activities, please describe any clinical, educational, practice management, or other situations that you find difficult to manage or resolve that you would like to see addressed:

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* 26. Do you have any other comments regarding this webinar?

PLEASE READ for CE CREDIT: When you click the “Submit and Receive Certificate” Button below, your web browser will automatically redirect to another webpage that contains all applicable disciplines’ certificates in downloadable PDFs. DO NOT close the browser before receiving your certificate. If you have technical difficulties, please email AGEC@uams.edu for assistance. Thank you!

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