Revised - The 8 PRACTICEs of Highly Successful Surgeons: Masters Class

Webinar #5

Reciprocity of Roles and Relationships

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* 1. Please rate your overall satisfaction with the organization of this meeting

Excellent

Good

Average

Fair

Poor

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* 2. Please enter the CME Master Codes

Opening Master Code:

Middle Master Code:

Ending Master Code:

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* 3. The ACCME defines commercial bias as presentations giving an unbalanced view of therapeutic options by promoting a specific proprietary business interest or a commercial interest.

Was this CME course free of commercial bias?

Yes

If no, please explain

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* 4. Did the faculty disclose significant relationships with commercial support?

Yes

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* 5. How well were the course objectives met?

Upon completion of the course, participants should be able to:

	Significantly Met	Somewhat Met	Not Met
Discuss the pathophysiology of Reciprocity of Roles and Relationships in our existing training and healthcare system as well as our lives	Discuss the pathophysiology of Reciprocity of Roles and Relationships in our existing training and healthcare system as well as our lives Significantly Met	Discuss the pathophysiology of Reciprocity of Roles and Relationships in our existing training and healthcare system as well as our lives Somewhat Met	Discuss the pathophysiology of Reciprocity of Roles and Relationships in our existing training and healthcare system as well as our lives Not Met
Create a personal plan with long- and short-term goals for creating reciprocity in your roles and relationships	Create a personal plan with long- and short-term goals for creating reciprocity in your roles and relationships Significantly Met	Create a personal plan with long- and short-term goals for creating reciprocity in your roles and relationships Somewhat Met	Create a personal plan with long- and short-term goals for creating reciprocity in your roles and relationships Not Met
Learn strategies to create focus on, and connection with, our Roles and Relationships using all of the 8 PRACTICEs	Learn strategies to create focus on, and connection with, our Roles and Relationships using all of the 8 PRACTICEs Significantly Met	Learn strategies to create focus on, and connection with, our Roles and Relationships using all of the 8 PRACTICEs Somewhat Met	Learn strategies to create focus on, and connection with, our Roles and Relationships using all of the 8 PRACTICEs Not Met
Implement a new reciprocity habit to replace an old negative habit using goal setting and accountability	Implement a new reciprocity habit to replace an old negative habit using goal setting and accountability Significantly Met	Implement a new reciprocity habit to replace an old negative habit using goal setting and accountability Somewhat Met	Implement a new reciprocity habit to replace an old negative habit using goal setting and accountability Not Met

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* 6. Did you meet your personal goal/objective for what you intended to get out of the course?

Significantly Met

Somewhat Met

Not Met

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* 7. Please rate the relevance of this program to your scope of practice

Very Relevant

Relevant

Somewhat Relevant

Not Very Relevant

Irrelevant

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* 8. Please rate the OVERALL EFFECTIVENESS of our speaker:

Excellent

Very Good

Good

Fair

Poor

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* 9. How would you rate your level of satisfaction with the reciprocity (give and take) of your roles and relationships (only those that apply, or those most important to you) in each of these areas? (10 = Completely satisfied)

	1	2	3	4	5	6	7	8	9	10
Yourself	Yourself 1	Yourself 2	Yourself 3	Yourself 4	Yourself 5	Yourself 6	Yourself 7	Yourself 8	Yourself 9	Yourself 10
Spiritual Being	Spiritual Being 1	Spiritual Being 2	Spiritual Being 3	Spiritual Being 4	Spiritual Being 5	Spiritual Being 6	Spiritual Being 7	Spiritual Being 8	Spiritual Being 9	Spiritual Being 10
Spouse / Significant Other	Spouse / Significant Other 1	Spouse / Significant Other 2	Spouse / Significant Other 3	Spouse / Significant Other 4	Spouse / Significant Other 5	Spouse / Significant Other 6	Spouse / Significant Other 7	Spouse / Significant Other 8	Spouse / Significant Other 9	Spouse / Significant Other 10
Mother	Mother 1	Mother 2	Mother 3	Mother 4	Mother 5	Mother 6	Mother 7	Mother 8	Mother 9	Mother 10
Father	Father 1	Father 2	Father 3	Father 4	Father 5	Father 6	Father 7	Father 8	Father 9	Father 10
Grandparents	Grandparents 1	Grandparents 2	Grandparents 3	Grandparents 4	Grandparents 5	Grandparents 6	Grandparents 7	Grandparents 8	Grandparents 9	Grandparents 10
Children	Children 1	Children 2	Children 3	Children 4	Children 5	Children 6	Children 7	Children 8	Children 9	Children 10
Siblings	Siblings 1	Siblings 2	Siblings 3	Siblings 4	Siblings 5	Siblings 6	Siblings 7	Siblings 8	Siblings 9	Siblings 10
Local Friends	Local Friends 1	Local Friends 2	Local Friends 3	Local Friends 4	Local Friends 5	Local Friends 6	Local Friends 7	Local Friends 8	Local Friends 9	Local Friends 10
Remote Friends	Remote Friends 1	Remote Friends 2	Remote Friends 3	Remote Friends 4	Remote Friends 5	Remote Friends 6	Remote Friends 7	Remote Friends 8	Remote Friends 9	Remote Friends 10
Same Specialty Surgeon Colleagues	Same Specialty Surgeon Colleagues 1	Same Specialty Surgeon Colleagues 2	Same Specialty Surgeon Colleagues 3	Same Specialty Surgeon Colleagues 4	Same Specialty Surgeon Colleagues 5	Same Specialty Surgeon Colleagues 6	Same Specialty Surgeon Colleagues 7	Same Specialty Surgeon Colleagues 8	Same Specialty Surgeon Colleagues 9	Same Specialty Surgeon Colleagues 10
Different Specialty Surgeon Colleagues	Different Specialty Surgeon Colleagues 1	Different Specialty Surgeon Colleagues 2	Different Specialty Surgeon Colleagues 3	Different Specialty Surgeon Colleagues 4	Different Specialty Surgeon Colleagues 5	Different Specialty Surgeon Colleagues 6	Different Specialty Surgeon Colleagues 7	Different Specialty Surgeon Colleagues 8	Different Specialty Surgeon Colleagues 9	Different Specialty Surgeon Colleagues 10
NonSurgeon Colleagues	NonSurgeon Colleagues 1	NonSurgeon Colleagues 2	NonSurgeon Colleagues 3	NonSurgeon Colleagues 4	NonSurgeon Colleagues 5	NonSurgeon Colleagues 6	NonSurgeon Colleagues 7	NonSurgeon Colleagues 8	NonSurgeon Colleagues 9	NonSurgeon Colleagues 10
Chairman or Department Leader	Chairman or Department Leader 1	Chairman or Department Leader 2	Chairman or Department Leader 3	Chairman or Department Leader 4	Chairman or Department Leader 5	Chairman or Department Leader 6	Chairman or Department Leader 7	Chairman or Department Leader 8	Chairman or Department Leader 9	Chairman or Department Leader 10
Hospital Administrators	Hospital Administrators 1	Hospital Administrators 2	Hospital Administrators 3	Hospital Administrators 4	Hospital Administrators 5	Hospital Administrators 6	Hospital Administrators 7	Hospital Administrators 8	Hospital Administrators 9	Hospital Administrators 10
Committee Members	Committee Members 1	Committee Members 2	Committee Members 3	Committee Members 4	Committee Members 5	Committee Members 6	Committee Members 7	Committee Members 8	Committee Members 9	Committee Members 10
Project Collaborator	Project Collaborator 1	Project Collaborator 2	Project Collaborator 3	Project Collaborator 4	Project Collaborator 5	Project Collaborator 6	Project Collaborator 7	Project Collaborator 8	Project Collaborator 9	Project Collaborator 10
Doctor / Patient	Doctor / Patient 1	Doctor / Patient 2	Doctor / Patient 3	Doctor / Patient 4	Doctor / Patient 5	Doctor / Patient 6	Doctor / Patient 7	Doctor / Patient 8	Doctor / Patient 9	Doctor / Patient 10
Surgeon / Surgical Team	Surgeon / Surgical Team 1	Surgeon / Surgical Team 2	Surgeon / Surgical Team 3	Surgeon / Surgical Team 4	Surgeon / Surgical Team 5	Surgeon / Surgical Team 6	Surgeon / Surgical Team 7	Surgeon / Surgical Team 8	Surgeon / Surgical Team 9	Surgeon / Surgical Team 10
Doctor / Patient Care Team	Doctor / Patient Care Team 1	Doctor / Patient Care Team 2	Doctor / Patient Care Team 3	Doctor / Patient Care Team 4	Doctor / Patient Care Team 5	Doctor / Patient Care Team 6	Doctor / Patient Care Team 7	Doctor / Patient Care Team 8	Doctor / Patient Care Team 9	Doctor / Patient Care Team 10
Other	Other 1	Other 2	Other 3	Other 4	Other 5	Other 6	Other 7	Other 8	Other 9	Other 10

Other (please specify)

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* 10. What is your short-term goal and/or new positive habit that you plan to implement regarding the reciprocity of roles and relationships?
(Alternatively, what is one role or relationship that you wish to create more focus, increase quality time, or improve trust, and how will you start to make that happen?)

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* 11. What is your long-term goal for the reciprocity of roles and relationships?
(Alternatively, what is the long-term goal that you seek out of that role or relationship?)

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* 12. What do you see as your BIGGEST challenge in implementing your new positive habit? What strategies could help to overcome this challenge?

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* 13. Are you intending to do an additional one-hour assignment to earn 1 additional CME credit?

Yes

Need more information

What is your additional assignment?

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* 14. How did you hear about this CME program?
Please complete this if this is your first Masters Class Webinar survey.

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* 15. Please provide your contact information
Please complete all lines if you are entering this information on a Masters Class survey for the first time.
(Name and email required to issue CME.)

Full Name *

Degree:
Surgical Subspecialty:

State/Province

Email Address *

Phone Number

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* 16. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The Foundation for Orthopaedic Research and Education (FORE) and Jeffrey M. Smith, MD - Surgeon Consulting

FORE is accredited by the ACCME to sponsor CME for physicians. Foundation for Orthopaedic Research & Education designates this live internet activity for a maximum of (2 AMA PRA Category 1 Credits™). Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Please attest to the total number of credit hours (minimum .25 - maximum 2) that you spent or plan to spend in this CME activity.

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* 17. Did you have any technical issues with the AnyMeeting Webinar?

Yes

If YES, please explain:

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* 1. Please rate your overall satisfaction with the organization of this meeting

Question Title

* 2. Please enter the CME Master Codes

Question Title

* 3. The ACCME defines commercial bias as presentations giving an unbalanced view of therapeutic options by promoting a specific proprietary business interest or a commercial interest. Was this CME course free of commercial bias?

Question Title

* 4. Did the faculty disclose significant relationships with commercial support?

Question Title

* 5. How well were the course objectives met? Upon completion of the course, participants should be able to:

Question Title

* 6. Did you meet your personal goal/objective for what you intended to get out of the course?

Question Title

* 7. Please rate the relevance of this program to your scope of practice

Question Title

* 8. Please rate the OVERALL EFFECTIVENESS of our speaker:

Question Title

* 9. How would you rate your level of satisfaction with the reciprocity (give and take) of your roles and relationships (only those that apply, or those most important to you) in each of these areas? (10 = Completely satisfied)

Question Title

Question Title

* 11. What is your long-term goal for the reciprocity of roles and relationships?(Alternatively, what is the long-term goal that you seek out of that role or relationship?)

Question Title

* 12. What do you see as your BIGGEST challenge in implementing your new positive habit? What strategies could help to overcome this challenge?

Question Title

* 13. Are you intending to do an additional one-hour assignment to earn 1 additional CME credit?

Question Title

* 14. How did you hear about this CME program?Please complete this if this is your first Masters Class Webinar survey.

Question Title

* 15. Please provide your contact informationPlease complete all lines if you are entering this information on a Masters Class survey for the first time.(Name and email required to issue CME.)

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* 17. Did you have any technical issues with the AnyMeeting Webinar?

* 3. The ACCME defines commercial bias as presentations giving an unbalanced view of therapeutic options by promoting a specific proprietary business interest or a commercial interest.

Was this CME course free of commercial bias?

* 5. How well were the course objectives met?

Upon completion of the course, participants should be able to:

* 11. What is your long-term goal for the reciprocity of roles and relationships?
(Alternatively, what is the long-term goal that you seek out of that role or relationship?)

* 14. How did you hear about this CME program?
Please complete this if this is your first Masters Class Webinar survey.

* 15. Please provide your contact information
Please complete all lines if you are entering this information on a Masters Class survey for the first time.
(Name and email required to issue CME.)