The Federation of State Physician Health Programs (FSPHP) and the American Society of Addiction Medicine (ASAM) are interested in your evaluation of the Enduring CME activity you have completed. FSPHP and ASAM will use your feedback to assess whether the training has met your needs and expectations, and to determine whether modifications are needed to improve future Enduring CME/Educational activities.

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* 1. Required for Enduring CME certificate.

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* 2. Are you a physician or a non-physician attendee?

Required for CME certificate.

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* 3. Which title best describes your professional role: (please check one)

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* 4. Please indicate how many years you have been in practice:

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* 5. Please indicate the extent to which the activity contributed to the achievement of your goals for this learning experience.

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* 6. The learning objectives for the activity are listed below.  They have been formulated to help participants assess the extent to which the activity provided them with new knowledge and/or skills. 

Please indicate the extent to which the learning objectives have been achieved.

  Greatly Well Achieved Satisfactorily Achieved Not Well Achieved Not At All
Develop evidence-based strategies and peer support resources to prevent healthcare professional burnout and decrease risk of suicide.
Utilize and integrate outcomes of mental, behavioral health and addiction services provided by Physician Health Programs to reduce conditions related to job stress.
Incorporate current methods to reduce barriers for health care professionals seeking support for their well-being and health including improvements in safe-haven legislation, rules, and regulations such as peer review, 42CFR, ADA, and HIPAA.
Manage changes in licensure and/or credentialing which increases privacy of health information while balancing the role of patient safety.
Critically review and analyze health care professional cases to improve best practices for identifying the prevalence, nature, and differential diagnosis of health care professionals at risk of substance use disorders.
Examine key sources of stress and apply a strengths-based approach to improve fulfillment and well-being in health care professionals and organizations.
Apply Physician Health Programs’ data-driven models which match the health care professionals' needs for evaluation, referral, treatment, and/or monitoring when issues of aging, professional boundaries, and determining fitness for duty are required.

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* 7. The following statements refer to the Enduring CME activity as a whole.  Please read each statement and use the scale to indicate how strongly you agree or disagree with the following statements.

  Strongly Agree Agree Disagree Strongly Disagree
The Enduring CME activity was well organized.
The material presented, and skills learned during this Enduring CME activity will be useful in caring for my patients and/or for my PHP practice.
The presenters were qualified and effective speakers.
The content presented was objective and free of commercial bias.
I expect to use the resources given during the Enduring CME activity.
My questions and issues were addressed during the Enduring CME activity.
I am satisfied with the overall Enduring CME activity.

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* 8. Based on your participation in this Enduring CME activity, please select the following strategies that you will incorporate into your practice: (check all that apply)

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* 9. Why did you participate in this activity? (check all that apply)

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* 10. If the content presented was relevant to your practice, what changes do you intend to make?

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* 11. If you selected "I am not certain yet; I may need additional information or strategies." in the previous question, please explain what else might be helpful:

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* 12. If you selected "This activity provided new knowledge and strategies that I can incorporate into my practice." in the previous question, please explain what you will do differently or what new strategy you may incorporate:

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* 13. List one barrier to implementing something that you learned in this activity:

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* 14. List additional comments/suggestions:

YOU ONLY NEED TO COMPLETE THIS ONE TIME.

YOU DO NOT HAVE TO COMPLETE THIS AGAIN.

THANK YOU!
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