1.First Name

2.Last Name

3.Email

4.For all ranking questions, use 5 as the best/highest and 1 as the lowest ranking.

The professional practice gap (educational needs) identified for this activity matches my current professional needs.

1 Does Not Meet My Needs

2

3

4

5 Meets My Needs

1 Does Not Meet My Needs

2

3

4

5 Meets My Needs

5.This CME activity promotes practical changes or strategies that will enhance my professional practice and competence.

1

2

3

4

5

1

2

3

4

5

6.This activity addresses areas of content that are relevant and have a direct impact on my professional practice or competence.

1

2

3

4

5

1

2

3

4

5

7.Based on the stated desired learning outcomes (ideal competence) designed for this activity, my professional practice is in need of improvement(s).

1

2

3

4

5

1

2

3

4

5

8.It is clear to me what the desired learning outcomes (educational objectives) are for this activity.

1

2

3

4

5

1

2

3

4

5