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HPV Vaccine and Provider-Parent Communication (Part 1A GRU CME Eval)

Georgia Regents University-Division of Continuing Education-Evaluation Form
SOWEGA-AHEC: HPV Vaccine and Provider-Parent Communication

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* 1. Name

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* 2. Mailing Address

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* 3. Office Phone Number & Fax Number

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* 4. Professional Degree & Specialty

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* 5. OBJECTIVES: At the conclusion of this activity, the participant should be able to: List the CDC’s recommendations for increasing HPV vaccination; identify and implement the “same way, same day” approach to HPV vaccination and introduce new practice tools to help support HPV vaccination in clinical health care settings. (1=Poor & 5=Excellent)

Please assess the presentation:

  1 (Poor) 2 3 4 5 (Excellent)
Overall content:
Objective(s) achieved:
Speaker's presentation style:

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* 6. Did the format of the activity allow you to achieve your desired results?

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* 7. Please assess the change in your clinical skill level. (1=Low & 5=High)

  1 (Poor) 2 3 4 5 (Excellent)
Clinical skill level before the activity.
Clinical skill level after the activity.
Rate your level of mastery of the material.

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* 8. This activity will assist in the improvement of my: (check all that apply)

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* 9. As a result of this session, list strategies that you will incorporate into your practice area:

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* 10. Please list suggestions for future topics and speakers:

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* 11. I plan to make the following changes to my practice: (check all that apply)

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* 12. What are the barriers you face in your current practice setting that may impact patient care: (check all that apply)

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* 13. Did the presentation contain anything that reflected commercial bias or influence?

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* 14. May we contact you for a post-activity evaluation to determine educational effectiveness?

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