CSIM Evaluation Form 2018 - W18. Practical Considerations for MAiD

CSIM Evaluation Form
Your feedback is invaluable and will help us improve the meeting and plan future educational activities.

Friday, October 12, 2018
W18. Practical Considerations for MAiD – Dr. Kim Wiebe

To thank you for completing these evaluation forms, we will hold a daily draw for a $25 Tim Hortons gift card. If you wish to enter, please indicate your name and email address. Winners will be announced on-site at the meeting and on social media.

Participation is optional; if you do not wish to participate, leave the following two fields blank.

One entry per session evaluated. Contact information will only be used for draw purposes. Survey responses are anonymous.

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* 1. Your Name

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* 2. Your Email Address

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* 3. Please rate this session as follows

	Poor	Fair	Satisfactory	Good	Excellent
Scientific content of this presentation	Scientific content of this presentation Poor	Scientific content of this presentation Fair	Scientific content of this presentation Satisfactory	Scientific content of this presentation Good	Scientific content of this presentation Excellent
Usefulness/practicality of this presentation	Usefulness/practicality of this presentation Poor	Usefulness/practicality of this presentation Fair	Usefulness/practicality of this presentation Satisfactory	Usefulness/practicality of this presentation Good	Usefulness/practicality of this presentation Excellent
Adequate time for questions/discussion	Adequate time for questions/discussion Poor	Adequate time for questions/discussion Fair	Adequate time for questions/discussion Satisfactory	Adequate time for questions/discussion Good	Adequate time for questions/discussion Excellent
Speaker effectiveness	Speaker effectiveness Poor	Speaker effectiveness Fair	Speaker effectiveness Satisfactory	Speaker effectiveness Good	Speaker effectiveness Excellent

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* 4. Session objectives were met

	Not at all	Partially	Mostly	Completely
Understand what criteria are used to determine if a patient is eligible for medical aid in dying.	Understand what criteria are used to determine if a patient is eligible for medical aid in dying. Not at all	Understand what criteria are used to determine if a patient is eligible for medical aid in dying. Partially	Understand what criteria are used to determine if a patient is eligible for medical aid in dying. Mostly	Understand what criteria are used to determine if a patient is eligible for medical aid in dying. Completely
Anticipate, troubleshoot and overcome challenges which may be encountered.	Anticipate, troubleshoot and overcome challenges which may be encountered. Not at all	Anticipate, troubleshoot and overcome challenges which may be encountered. Partially	Anticipate, troubleshoot and overcome challenges which may be encountered. Mostly	Anticipate, troubleshoot and overcome challenges which may be encountered. Completely
Access resources available to physicians for moral, spiritual and emotional support.	Access resources available to physicians for moral, spiritual and emotional support. Not at all	Access resources available to physicians for moral, spiritual and emotional support. Partially	Access resources available to physicians for moral, spiritual and emotional support. Mostly	Access resources available to physicians for moral, spiritual and emotional support. Completely
Outline assessment documentation for one provincial body.	Outline assessment documentation for one provincial body. Not at all	Outline assessment documentation for one provincial body. Partially	Outline assessment documentation for one provincial body. Mostly	Outline assessment documentation for one provincial body. Completely

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* 5. Which CanMEDS roles do you feel were addressed during this educational activity?

Medical Expert

Scholar

Collaborator

Health Advocate

Communicator

Leader

Professional

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* 6. Outcomes: As a result of attending this session, are you planning to

	Yes	No	Maybe
Discuss the session with your colleagues	Discuss the session with your colleagues Yes	Discuss the session with your colleagues No	Discuss the session with your colleagues Maybe
Pursue additional learning activities	Pursue additional learning activities Yes	Pursue additional learning activities No	Pursue additional learning activities Maybe
Complete a Personal Learning Project (PLP)	Complete a Personal Learning Project (PLP) Yes	Complete a Personal Learning Project (PLP) No	Complete a Personal Learning Project (PLP) Maybe

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* 7. What new information did you learn from this session?

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* 8. What changes will you make as a result?

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* 9. As part of its continuing professional development efforts, the CSIM would like to follow up with you in three months regarding potential impact this session had on your practice.

No, do not contact me.

Yes, CSIM may contact me as noted above – please indicate your name and email below:

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* 10. If you clicked "yes" above, please indicate your name and email address below:

First Name

Last Name

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* 11. Bias and Balance

	Yes	No	Unsure
The content of this presentation was scientifically valid and balanced	The content of this presentation was scientifically valid and balanced Yes	The content of this presentation was scientifically valid and balanced No	The content of this presentation was scientifically valid and balanced Unsure
This session WAS FREE from indicators of undue industry bias	This session WAS FREE from indicators of undue industry bias Yes	This session WAS FREE from indicators of undue industry bias No	This session WAS FREE from indicators of undue industry bias Unsure
This session WAS FREE from indicators of undue personal/other bias	This session WAS FREE from indicators of undue personal/other bias Yes	This session WAS FREE from indicators of undue personal/other bias No	This session WAS FREE from indicators of undue personal/other bias Unsure

If you feel there were indicators of bias, please describe:
(Note: Bias is defined as "a personal judgment in favor of a specific proprietary business interest or a commercial interest.")

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* 12. General Comments

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* 13. Topic suggestions for future conferences (please be as specific as possible)

An evaluation form for general conference feedback is available on the CSIM website and will also be emailed to you after the conference.

Thank you for your feedback.