COS 2019: CME Evaluation & Claim Form Survey

NOTE: Survey open date: July 31, 2019

Physicians, in order to receive Category 1 credit, please complete this evaluation survey and electronically sign the CME Claim Form at the end of the survey. Information obtained from you regarding the impact of the sessions in meeting your learning needs or practice gaps is critical to the development of future educational programs. Please take the time to complete this evaluation form as completely as possible. Thank you for your valuable feedback!

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
The program met my expectations.	The program met my expectations. Strongly Agree	The program met my expectations. Agree	The program met my expectations. Neutral	The program met my expectations. Disagree	The program met my expectations. Strongly Disagree
The program format/schedule was effective.	The program format/schedule was effective. Strongly Agree	The program format/schedule was effective. Agree	The program format/schedule was effective. Neutral	The program format/schedule was effective. Disagree	The program format/schedule was effective. Strongly Disagree
The program met my educational needs.	The program met my educational needs. Strongly Agree	The program met my educational needs. Agree	The program met my educational needs. Neutral	The program met my educational needs. Disagree	The program met my educational needs. Strongly Disagree
I learned skills and concepts that will help me be more effective and strategic in my work.	I learned skills and concepts that will help me be more effective and strategic in my work. Strongly Agree	I learned skills and concepts that will help me be more effective and strategic in my work. Agree	I learned skills and concepts that will help me be more effective and strategic in my work. Neutral	I learned skills and concepts that will help me be more effective and strategic in my work. Disagree	I learned skills and concepts that will help me be more effective and strategic in my work. Strongly Disagree
The program provided me with new ideas, information and/or resources.	The program provided me with new ideas, information and/or resources. Strongly Agree	The program provided me with new ideas, information and/or resources. Agree	The program provided me with new ideas, information and/or resources. Neutral	The program provided me with new ideas, information and/or resources. Disagree	The program provided me with new ideas, information and/or resources. Strongly Disagree
The presentations were commercially unbiased and fair.	The presentations were commercially unbiased and fair. Strongly Agree	The presentations were commercially unbiased and fair. Agree	The presentations were commercially unbiased and fair. Neutral	The presentations were commercially unbiased and fair. Disagree	The presentations were commercially unbiased and fair. Strongly Disagree

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

The program met my expectations.

The program met my expectations. Strongly Agree

The program met my expectations. Agree

The program met my expectations. Neutral

The program met my expectations. Disagree

The program met my expectations. Strongly Disagree

The program format/schedule was effective.

The program format/schedule was effective. Strongly Agree

The program format/schedule was effective. Agree

The program format/schedule was effective. Neutral

The program format/schedule was effective. Disagree

The program format/schedule was effective. Strongly Disagree

The program met my educational needs.

The program met my educational needs. Strongly Agree

The program met my educational needs. Agree

The program met my educational needs. Neutral

The program met my educational needs. Disagree

The program met my educational needs. Strongly Disagree

I learned skills and concepts that will help me be more effective and strategic in my work.

I learned skills and concepts that will help me be more effective and strategic in my work. Strongly Agree

I learned skills and concepts that will help me be more effective and strategic in my work. Agree

I learned skills and concepts that will help me be more effective and strategic in my work. Neutral

I learned skills and concepts that will help me be more effective and strategic in my work. Disagree

I learned skills and concepts that will help me be more effective and strategic in my work. Strongly Disagree

The program provided me with new ideas, information and/or resources.

The program provided me with new ideas, information and/or resources. Strongly Agree

The program provided me with new ideas, information and/or resources. Agree

The program provided me with new ideas, information and/or resources. Neutral

The program provided me with new ideas, information and/or resources. Disagree

The program provided me with new ideas, information and/or resources. Strongly Disagree

The presentations were commercially unbiased and fair.

The presentations were commercially unbiased and fair. Strongly Agree

The presentations were commercially unbiased and fair. Agree

The presentations were commercially unbiased and fair. Neutral

The presentations were commercially unbiased and fair. Disagree

The presentations were commercially unbiased and fair. Strongly Disagree

Excellent

Good

Neutral

Fair

Poor

Excellent

Good

Neutral

Fair

Poor

Excellent

Good

Neutral

Fair

Poor

Excellent

Good

Neutral

Fair

Poor

	Excellent	Good	Adequate	Fair	Poor
Jean Hausheer, MD	Jean Hausheer, MD Excellent	Jean Hausheer, MD Good	Jean Hausheer, MD Adequate	Jean Hausheer, MD Fair	Jean Hausheer, MD Poor
Glenn Strauss, MD	Glenn Strauss, MD Excellent	Glenn Strauss, MD Good	Glenn Strauss, MD Adequate	Glenn Strauss, MD Fair	Glenn Strauss, MD Poor
Stan Pletcher, MD	Stan Pletcher, MD Excellent	Stan Pletcher, MD Good	Stan Pletcher, MD Adequate	Stan Pletcher, MD Fair	Stan Pletcher, MD Poor
Andy Moyes, MD	Andy Moyes, MD Excellent	Andy Moyes, MD Good	Andy Moyes, MD Adequate	Andy Moyes, MD Fair	Andy Moyes, MD Poor

Excellent

Good

Adequate

Fair

Poor

Jean Hausheer, MD

Jean Hausheer, MD Excellent

Jean Hausheer, MD Good

Jean Hausheer, MD Adequate

Jean Hausheer, MD Fair

Jean Hausheer, MD Poor

Glenn Strauss, MD

Glenn Strauss, MD Excellent

Glenn Strauss, MD Good

Glenn Strauss, MD Adequate

Glenn Strauss, MD Fair

Glenn Strauss, MD Poor

Stan Pletcher, MD

Stan Pletcher, MD Excellent

Stan Pletcher, MD Good

Stan Pletcher, MD Adequate

Stan Pletcher, MD Fair

Stan Pletcher, MD Poor

Andy Moyes, MD

Andy Moyes, MD Excellent

Andy Moyes, MD Good

Andy Moyes, MD Adequate

Andy Moyes, MD Fair

Andy Moyes, MD Poor

	Excellent	Good	Adequate	Fair	Poor
Scientific Poster Session	Scientific Poster Session Excellent	Scientific Poster Session Good	Scientific Poster Session Adequate	Scientific Poster Session Fair	Scientific Poster Session Poor
Ajay Singh, MD	Ajay Singh, MD Excellent	Ajay Singh, MD Good	Ajay Singh, MD Adequate	Ajay Singh, MD Fair	Ajay Singh, MD Poor
William L. White, MD	William L. White, MD Excellent	William L. White, MD Good	William L. White, MD Adequate	William L. White, MD Fair	William L. White, MD Poor
Jason Leng, MD	Jason Leng, MD Excellent	Jason Leng, MD Good	Jason Leng, MD Adequate	Jason Leng, MD Fair	Jason Leng, MD Poor
Glenn Strauss, MD	Glenn Strauss, MD Excellent	Glenn Strauss, MD Good	Glenn Strauss, MD Adequate	Glenn Strauss, MD Fair	Glenn Strauss, MD Poor
Scott Lee, MD	Scott Lee, MD Excellent	Scott Lee, MD Good	Scott Lee, MD Adequate	Scott Lee, MD Fair	Scott Lee, MD Poor
Shark Tank	Shark Tank Excellent	Shark Tank Good	Shark Tank Adequate	Shark Tank Fair	Shark Tank Poor

Excellent

Good

Adequate

Fair

Poor

Scientific Poster Session

Scientific Poster Session Excellent

Scientific Poster Session Good

Scientific Poster Session Adequate

Scientific Poster Session Fair

Scientific Poster Session Poor

Ajay Singh, MD

Ajay Singh, MD Excellent

Ajay Singh, MD Good

Ajay Singh, MD Adequate

Ajay Singh, MD Fair

Ajay Singh, MD Poor

William L. White, MD

William L. White, MD Excellent

William L. White, MD Good

William L. White, MD Adequate

William L. White, MD Fair

William L. White, MD Poor

Jason Leng, MD

Jason Leng, MD Excellent

Jason Leng, MD Good

Jason Leng, MD Adequate

Jason Leng, MD Fair

Jason Leng, MD Poor

Glenn Strauss, MD

Glenn Strauss, MD Excellent

Glenn Strauss, MD Good

Glenn Strauss, MD Adequate

Glenn Strauss, MD Fair

Glenn Strauss, MD Poor

Scott Lee, MD

Scott Lee, MD Excellent

Scott Lee, MD Good

Scott Lee, MD Adequate

Scott Lee, MD Fair

Scott Lee, MD Poor

Shark Tank

Shark Tank Excellent

Shark Tank Good

Shark Tank Adequate

Shark Tank Fair

Shark Tank Poor

	Excellent	Good	Adequate	Fair	Poor
Scientific Poster Session	Scientific Poster Session Excellent	Scientific Poster Session Good	Scientific Poster Session Adequate	Scientific Poster Session Fair	Scientific Poster Session Poor
James O'Brien, MD	James O'Brien, MD Excellent	James O'Brien, MD Good	James O'Brien, MD Adequate	James O'Brien, MD Fair	James O'Brien, MD Poor
Andy Moyes, MD	Andy Moyes, MD Excellent	Andy Moyes, MD Good	Andy Moyes, MD Adequate	Andy Moyes, MD Fair	Andy Moyes, MD Poor
Steven Sarkisian, Jr., MD	Steven Sarkisian, Jr., MD Excellent	Steven Sarkisian, Jr., MD Good	Steven Sarkisian, Jr., MD Adequate	Steven Sarkisian, Jr., MD Fair	Steven Sarkisian, Jr., MD Poor
James Matthew Rouse, MD	James Matthew Rouse, MD Excellent	James Matthew Rouse, MD Good	James Matthew Rouse, MD Adequate	James Matthew Rouse, MD Fair	James Matthew Rouse, MD Poor
Jamie Paauw, MD	Jamie Paauw, MD Excellent	Jamie Paauw, MD Good	Jamie Paauw, MD Adequate	Jamie Paauw, MD Fair	Jamie Paauw, MD Poor
Patrick Sweeeney, MD	Patrick Sweeeney, MD Excellent	Patrick Sweeeney, MD Good	Patrick Sweeeney, MD Adequate	Patrick Sweeeney, MD Fair	Patrick Sweeeney, MD Poor
Jean Hausheer, MD	Jean Hausheer, MD Excellent	Jean Hausheer, MD Good	Jean Hausheer, MD Adequate	Jean Hausheer, MD Fair	Jean Hausheer, MD Poor
God Lab	God Lab Excellent	God Lab Good	God Lab Adequate	God Lab Fair	God Lab Poor
MIGS Wetlab	MIGS Wetlab Excellent	MIGS Wetlab Good	MIGS Wetlab Adequate	MIGS Wetlab Fair	MIGS Wetlab Poor
Missionary Highlight	Missionary Highlight Excellent	Missionary Highlight Good	Missionary Highlight Adequate	Missionary Highlight Fair	Missionary Highlight Poor

Excellent

Good

Adequate

Fair

Poor

Scientific Poster Session

Scientific Poster Session Excellent

Scientific Poster Session Good

Scientific Poster Session Adequate

Scientific Poster Session Fair

Scientific Poster Session Poor

James O'Brien, MD

James O'Brien, MD Excellent

James O'Brien, MD Good

James O'Brien, MD Adequate

James O'Brien, MD Fair

James O'Brien, MD Poor

Andy Moyes, MD

Andy Moyes, MD Excellent

Andy Moyes, MD Good

Andy Moyes, MD Adequate

Andy Moyes, MD Fair

Andy Moyes, MD Poor

Steven Sarkisian, Jr., MD

Steven Sarkisian, Jr., MD Excellent

Steven Sarkisian, Jr., MD Good

Steven Sarkisian, Jr., MD Adequate

Steven Sarkisian, Jr., MD Fair

Steven Sarkisian, Jr., MD Poor

James Matthew Rouse, MD

James Matthew Rouse, MD Excellent

James Matthew Rouse, MD Good

James Matthew Rouse, MD Adequate

James Matthew Rouse, MD Fair

James Matthew Rouse, MD Poor

Jamie Paauw, MD

Jamie Paauw, MD Excellent

Jamie Paauw, MD Good

Jamie Paauw, MD Adequate

Jamie Paauw, MD Fair

Jamie Paauw, MD Poor

Patrick Sweeeney, MD

Patrick Sweeeney, MD Excellent

Patrick Sweeeney, MD Good

Patrick Sweeeney, MD Adequate

Patrick Sweeeney, MD Fair

Patrick Sweeeney, MD Poor

Jean Hausheer, MD

Jean Hausheer, MD Excellent

Jean Hausheer, MD Good

Jean Hausheer, MD Adequate

Jean Hausheer, MD Fair

Jean Hausheer, MD Poor

God Lab

God Lab Excellent

God Lab Good

God Lab Adequate

God Lab Fair

God Lab Poor

MIGS Wetlab

MIGS Wetlab Excellent

MIGS Wetlab Good

MIGS Wetlab Adequate

MIGS Wetlab Fair

MIGS Wetlab Poor

Missionary Highlight

Missionary Highlight Excellent

Missionary Highlight Good

Missionary Highlight Adequate

Missionary Highlight Fair

Missionary Highlight Poor

	Excellent	Good	Adequate	Fair	Poor
Superbowl of Grand Rounds	Superbowl of Grand Rounds Excellent	Superbowl of Grand Rounds Good	Superbowl of Grand Rounds Adequate	Superbowl of Grand Rounds Fair	Superbowl of Grand Rounds Poor
Jemshed Khan, MD	Jemshed Khan, MD Excellent	Jemshed Khan, MD Good	Jemshed Khan, MD Adequate	Jemshed Khan, MD Fair	Jemshed Khan, MD Poor
Mark Micheletti	Mark Micheletti Excellent	Mark Micheletti Good	Mark Micheletti Adequate	Mark Micheletti Fair	Mark Micheletti Poor

Excellent

Good

Adequate

Fair

Poor

Superbowl of Grand Rounds

Superbowl of Grand Rounds Excellent

Superbowl of Grand Rounds Good

Superbowl of Grand Rounds Adequate

Superbowl of Grand Rounds Fair

Superbowl of Grand Rounds Poor

Jemshed Khan, MD

Jemshed Khan, MD Excellent

Jemshed Khan, MD Good

Jemshed Khan, MD Adequate

Jemshed Khan, MD Fair

Jemshed Khan, MD Poor

Mark Micheletti

Mark Micheletti Excellent

Mark Micheletti Good

Mark Micheletti Adequate

Mark Micheletti Fair

Mark Micheletti Poor

COS 2019: CME Evaluation & Claim Form

Section I: Overall Program Evaluation

Question Title

* 1. Please enter your name.

Question Title

* 2. Regarding overall program effectiveness, please rate the following statements.

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* 3. The location was:

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* 4. The overall quality of the conference was:

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* 5. What topics would you like to see covered at future events? What skills would you like to develop in the future?

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* 6. Are there barriers that still need to be addressed?

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* 7. Please rate the following Wednesday speakers/sessions based on their knowledge of the material, efficient use of time and applicability of material.

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* 8. Please rate the following Thursday speakers/sessions based on their knowledge of the material, efficient use of time and applicability of material.

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* 9. Please rate the following Friday speakers/sessions based on their knowledge of the material, efficient use of time and applicability of material.

Question Title

* 10. Please rate the following Saturday speakers/sessions based on their knowledge of the material, efficient use of time and applicability of material.