Screen Reader Mode Icon

Question Title

* 1. First Name (required):

Question Title

* 2. Last Name (required)

Question Title

* 3. For all ranking questions, please use 5 as the best/highest and 1 as the lowest ranking.

This activity met with my current professional needs.

Question Title

* 4. Upon completion of this activity, I feel empowered to implement specific changes or strategies that will enhance my professional practice and competence.

Question Title

* 5. The content of this activity served to enhance my professional practice and competence.

Question Title

* 6. It is clear to me how I would implement the desired learning outcomes (changes or new strategies) in my practice, if given the chance.

Question Title

* 7. The content of this CME activity matches my scope of professional practice (i.e. primary care, specialty, subspecialty, healthcare team member, administrative staff member, hospitalist, healthcare executive, etc.)

Question Title

* 8. The selected faculty members, moderators and/or facilitators met with my professional expectations.

Question Title

* 9. The educational design and format chosen for this activity were appropriate for the setting, and desired learning outcomes.

Question Title

* 10. In what way could this CME activity be improved? (Please respond in terms of content, faculty selection, learning outcomes or expected changes, etc)

Question Title

* 11. What were some of the strengths of this CME activity?

Question Title

* 12. As a result of this activity, and in striving for ideal professional practice and competence, I will make the following changes: • Yes Please List Three (3) Changes:

Question Title

* 13. Did this CME activity actively promote improvements in health care that were free of commercial bias and/or promotion?

Question Title

* 14. Please list at least (3) professional practice gaps (educational needs or problem areas) that you would like to see addressed for your practice in future CME activities:

Question Title

* 15. Signature (required):

T