Name of RSS Activity

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* 1. Name of RSS Activity

Name of Course Director

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* 2. Name of Course Director

Type of RSS

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* 3. Type of RSS

Based on an analysis of your evaluation data:

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* 4. Based on an analysis of your evaluation data:

  Very effective Effective Neutral Ineffective Very ineffective
How effective was this RSS activity in meeting the overall objectives for the series?
How effective was this series for improving the knowledge level of the learners?
How effective was this series for improving the learner's ability to adopt or modify skills or strategies in their professional responsibilities?
How effective was the series in achieving the intended results in terms of patient outcomes (i.e., patient safety & quality; decrease in unnecessary expenses; more appropriate prescribing; implementation of best practices; reduction in medical errors, etc.)
Was this RSS interprofessional?

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* 5. Was this RSS interprofessional?

Please indicate how effective the series was in improving the learner's ability to:

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* 6. Please indicate how effective the series was in improving the learner's ability to:

  Very effective Effective Neutral Ineffective Very ineffective Not applicable this series was not interprofessional
Apply the knowledge and/or skills acquired from this RSS when in a team environment?
Collaborate with a multidisciplinary team?
Communicate with other members of an interprofessional team?
Discuss how teamwork can contribute to continuous and reliable patient care?
Please indicate which of the following American Board of Medical Specialties/Institute of Medicine core competencies have been addressed by this series (select all that apply):

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* 7. Please indicate which of the following American Board of Medical Specialties/Institute of Medicine core competencies have been addressed by this series (select all that apply):

Please indicate which of the interprofessional core competencies were addressed during the series (select all that apply)

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* 8. Please indicate which of the interprofessional core competencies were addressed during the series (select all that apply)

What could the planning committee do to improve meeting the interprofessional core competencies in the next annual RSS? If not interprofessional, indicate changes you are considering to move it to be interprofessional education.

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* 9. What could the planning committee do to improve meeting the interprofessional core competencies in the next annual RSS? If not interprofessional, indicate changes you are considering to move it to be interprofessional education.

Please tell us about reportable outcomes that are outside the scope of these questions. For example, a learner report of a notable application into their work of something learned in this RSS, development of a new procedure or adoption of a protocol, patient safety issue addressed, observation of improved team skills, etc.

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* 10. Please tell us about reportable outcomes that are outside the scope of these questions. For example, a learner report of a notable application into their work of something learned in this RSS, development of a new procedure or adoption of a protocol, patient safety issue addressed, observation of improved team skills, etc.

What barriers did you or your learners identify as potentially preventing their incorporating what they learned in this series into their work?

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* 11. What barriers did you or your learners identify as potentially preventing their incorporating what they learned in this series into their work?

Please indicate ideas you may use to address the identified barriers in next year's RSS (mark all that apply):

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* 12. Please indicate ideas you may use to address the identified barriers in next year's RSS (mark all that apply):

Did you try an innovative approach to the RSS in this past year?

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* 13. Did you try an innovative approach to the RSS in this past year?

Please mark all that apply about how the RSS series addressed quality improvement or patient safety issues:

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* 14. Please mark all that apply about how the RSS series addressed quality improvement or patient safety issues:

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