The Office of Continuing Professional Development and TEACH

Note: You will be required to answer two questions from the video for CME credit.
The starred (*) fields require answers.

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* 1. Name

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* 2. Title:

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* 3. Department:

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* 4. Email Address

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* 5. Date you watched

Date

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* 6. What presentation are you requesting CME credit for?

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* 7. Did you receive disclosure information at the beginning of the presentation?

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* 8. Was the speaker biased in the discussion of any product(s) or service(s)?

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* 9. Tell us two distinct things you learned.

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* 10. Based on this lecture what do you feel more competent doing?

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* 11. Based on what you learned from this lecture tell us one thing you will commit to change in your practice.

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* 12. Please rate each section.

  Excellent Very Good Acceptable Fair
Content was relevant to my needs
Objectives were accomplished
Speaker was organized
Overall Evaluation

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* 13. Question 1 from the presentation.

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* 14. Question 2 from the presentation.

Reminder!  You can access your CME report using the CME Tracker at www.carilionclinic.org/continuing-medical-education.

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