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* 1. UAMS Employee

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* 2. Profession

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* 3. Practice Type

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* 4. Practice Setting

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* 5. 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
Objective:  Identify the causes of malnutrition due to the aging process
Objective:  Review the Mediterranean Diet and how it helps decrease mortality in the elderly
Objective:  Apply interventions that can help improve mortality and QOL for the elderly
Objective:  Describe common nutrition-related GI symptoms in geriatric patients and epidemiologic differences
Objective:  Identify a healthy diet in elderly patients and any differences from general recommendations
Objective:  Discuss lifestyle factors contributing to bowel/GI tract health and well-being in seniors

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* 6. I work as a member of a health care team

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* 7. 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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* 8. 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.)    
*The Accreditation Council for CME requires us to analyze changes in learners’ competence, performance, or patient outcomes.

  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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* 9. Do you feel the activity was scientifically sound and free of commercial bias* or influence?
*Commercial bias is defined as a personal judgment in favor of a specific product or service of a commercial interest.

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

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

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

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

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* 14. Overall, were the speakers knowledgeable regarding the content?

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* 15. Overall, were the presentations balanced, objective, and scientifically rigorous?

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* 16. Describe any presentations that were exceptional?

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* 17. Describe any presentations that did not meet your needs or expectations.

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* 18. 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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