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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
1.Name
2.Mailing Address
3.Office Phone Number & Fax Number
4.Professional Degree & Specialty
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:
6.Did the format of the activity allow you to achieve your desired results?
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.
8.This activity will assist in the improvement of my: (check all that apply)
9.As a result of this session, list strategies that you will incorporate into your practice area:
10.Please list suggestions for future topics and speakers:
11.I plan to make the following changes to my practice: (check all that apply)
12.What are the barriers you face in your current practice setting that may impact patient care: (check all that apply)
13.Did the presentation contain anything that reflected commercial bias or influence?
14.May we contact you for a post-activity evaluation to determine educational effectiveness?
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