2019 PAMC Ethics Forum (3rd Thursdays every other month starting in February)

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* 1. Please share your contact information:

First Name

Last Name

Job Title

Email Address

Work Phone

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* 2. Please select the date of the meeting for which you'd like to evaluate and claim CME:
(If the date of the meeting is not listed, it was not approved for CME)

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* 3. Are you a...

MD/DO

PA-C

Other (please specify)

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* 4. How many credit hours are you claiming for this session?
(The maximum is 1.0)

.25 hours

.5 hours

.75 hours

1.0 hours

Ensuring Independence of CME Activities: Providence Health & Services Alaska is committed to providing education that is free from bias of commercial interests. In an effort to assist us in ensuring this is always the case, please complete the following question.

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* 5. Did you find the information presented in the session you attended to be fair, objective, and free of commercial bias?

If no, please describe:

Program Efficacy: The following questions help Providence Health & Services Alaska evaluate the efficacy of the various programs. As an accredited provider, it is critical that we measure and evaluate changes in Competence, Performance and Patient Outcomes. Please assist us in fulfilling our educational mission by answering the following questions.

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* 6. Assessment of Expected Learner Outcomes: On a scale of 1-5, with 5 being the highest, please rate the degree to which you intend to do or apply the following to your practice/ for the benefit of your patients:

	1 - I do not intend to make any changes	2	3 - I will make a few changes	4	5 - I intend to make a lot of changes
Stop using your gut instincts to poorly navigate ethical issues in the clinic.	Stop using your gut instincts to poorly navigate ethical issues in the clinic. 1 - I do not intend to make any changes	Stop using your gut instincts to poorly navigate ethical issues in the clinic. 2	Stop using your gut instincts to poorly navigate ethical issues in the clinic. 3 - I will make a few changes	Stop using your gut instincts to poorly navigate ethical issues in the clinic. 4	Stop using your gut instincts to poorly navigate ethical issues in the clinic. 5 - I intend to make a lot of changes
Start using standard methods of clinical ethics.	Start using standard methods of clinical ethics. 1 - I do not intend to make any changes	Start using standard methods of clinical ethics. 2	Start using standard methods of clinical ethics. 3 - I will make a few changes	Start using standard methods of clinical ethics. 4	Start using standard methods of clinical ethics. 5 - I intend to make a lot of changes
Learn particular bits of knowledge on the various topics addressed through the year.	Learn particular bits of knowledge on the various topics addressed through the year. 1 - I do not intend to make any changes	Learn particular bits of knowledge on the various topics addressed through the year. 2	Learn particular bits of knowledge on the various topics addressed through the year. 3 - I will make a few changes	Learn particular bits of knowledge on the various topics addressed through the year. 4	Learn particular bits of knowledge on the various topics addressed through the year. 5 - I intend to make a lot of changes

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* 7. Assessing changes in Competence: What did you learn at the session that you plan to take back and apply to practice? Please highlight what you found valuable and how you plan to apply it to practice.

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* 8. Assessing potential impact on Patient Outcomes: Please describe how the information you obtained during the presentation will directly impact patient care/outcomes. Speculation is encouraged!

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* 9. What barriers may prevent you from applying knowledge and/or techniques to practice?

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* 10. Please let us know what future topics you would like to see presented:

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* 11. Maintenance of Certification for ABIM: This activity is pending approval for MOC Type 2. If you wish for your credits to be applied if/when approval occurs, please complete the information below. By completing this section you are granting the CME staff permission to share your participation data with the ACCME who in turn will report to the Board.

Date of Birth

ABIM ID: Every ABIM Board Certified physician has a unique, six-digit ABIM ID number. Look up here: http://www.abim.org/verify-physician.aspx

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* 1. Please share your contact information:

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* 2. Please select the date of the meeting for which you'd like to evaluate and claim CME:(If the date of the meeting is not listed, it was not approved for CME)

Question Title

* 3. Are you a...

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* 4. How many credit hours are you claiming for this session? (The maximum is 1.0)

Question Title

* 5. Did you find the information presented in the session you attended to be fair, objective, and free of commercial bias?

Question Title

* 6. Assessment of Expected Learner Outcomes: On a scale of 1-5, with 5 being the highest, please rate the degree to which you intend to do or apply the following to your practice/ for the benefit of your patients:

Question Title

* 7. Assessing changes in Competence: What did you learn at the session that you plan to take back and apply to practice? Please highlight what you found valuable and how you plan to apply it to practice.

Question Title

* 8. Assessing potential impact on Patient Outcomes: Please describe how the information you obtained during the presentation will directly impact patient care/outcomes. Speculation is encouraged!

Question Title

* 9. What barriers may prevent you from applying knowledge and/or techniques to practice?

Question Title

* 10. Please let us know what future topics you would like to see presented:

Question Title

* 2. Please select the date of the meeting for which you'd like to evaluate and claim CME:
(If the date of the meeting is not listed, it was not approved for CME)

* 4. How many credit hours are you claiming for this session?
(The maximum is 1.0)