Program Evaluation Survey

Instructions: Please use the scale below to rate the following questions:

1= Totally ineffective, would not recommend

2= Somewhat ineffective, having at least one serious deficiency

3= Somewhat effective, acceptable but not outstanding

4= Effective, meets high standards, would recommend to others

5= Highly effective, among the best I've ever attended

	1	2	3	4	5
1. Identify barriers in having end-of-life conversations with our patients	1. Identify barriers in having end-of-life conversations with our patients 1	1. Identify barriers in having end-of-life conversations with our patients 2	1. Identify barriers in having end-of-life conversations with our patients 3	1. Identify barriers in having end-of-life conversations with our patients 4	1. Identify barriers in having end-of-life conversations with our patients 5
2. Describe better language to use in having end-of-life conversations	2. Describe better language to use in having end-of-life conversations 1	2. Describe better language to use in having end-of-life conversations 2	2. Describe better language to use in having end-of-life conversations 3	2. Describe better language to use in having end-of-life conversations 4	2. Describe better language to use in having end-of-life conversations 5
3. Identify ways to use a multidisciplinary team to overcome barriers to end-of-life conversations	3. Identify ways to use a multidisciplinary team to overcome barriers to end-of-life conversations 1	3. Identify ways to use a multidisciplinary team to overcome barriers to end-of-life conversations 2	3. Identify ways to use a multidisciplinary team to overcome barriers to end-of-life conversations 3	3. Identify ways to use a multidisciplinary team to overcome barriers to end-of-life conversations 4	3. Identify ways to use a multidisciplinary team to overcome barriers to end-of-life conversations 5
4. Describe the new billing codes and how to use them to be reimbursed for end-of-life conversations	4. Describe the new billing codes and how to use them to be reimbursed for end-of-life conversations 1	4. Describe the new billing codes and how to use them to be reimbursed for end-of-life conversations 2	4. Describe the new billing codes and how to use them to be reimbursed for end-of-life conversations 3	4. Describe the new billing codes and how to use them to be reimbursed for end-of-life conversations 4	4. Describe the new billing codes and how to use them to be reimbursed for end-of-life conversations 5

1. Identify barriers in having end-of-life conversations with our patients

1. Identify barriers in having end-of-life conversations with our patients 1

1. Identify barriers in having end-of-life conversations with our patients 2

1. Identify barriers in having end-of-life conversations with our patients 3

1. Identify barriers in having end-of-life conversations with our patients 4

1. Identify barriers in having end-of-life conversations with our patients 5

2. Describe better language to use in having end-of-life conversations

2. Describe better language to use in having end-of-life conversations 1

2. Describe better language to use in having end-of-life conversations 2

2. Describe better language to use in having end-of-life conversations 3

2. Describe better language to use in having end-of-life conversations 4

2. Describe better language to use in having end-of-life conversations 5

3. Identify ways to use a multidisciplinary team to overcome barriers to end-of-life conversations

3. Identify ways to use a multidisciplinary team to overcome barriers to end-of-life conversations 1

3. Identify ways to use a multidisciplinary team to overcome barriers to end-of-life conversations 2

3. Identify ways to use a multidisciplinary team to overcome barriers to end-of-life conversations 3

3. Identify ways to use a multidisciplinary team to overcome barriers to end-of-life conversations 4

3. Identify ways to use a multidisciplinary team to overcome barriers to end-of-life conversations 5

4. Describe the new billing codes and how to use them to be reimbursed for end-of-life conversations

4. Describe the new billing codes and how to use them to be reimbursed for end-of-life conversations 1

4. Describe the new billing codes and how to use them to be reimbursed for end-of-life conversations 2

4. Describe the new billing codes and how to use them to be reimbursed for end-of-life conversations 3

4. Describe the new billing codes and how to use them to be reimbursed for end-of-life conversations 4

4. Describe the new billing codes and how to use them to be reimbursed for end-of-life conversations 5

	1	2	3	4	5
a. Presentation Style	a. Presentation Style 1	a. Presentation Style 2	a. Presentation Style 3	a. Presentation Style 4	a. Presentation Style 5
b. Knowledge of Subject	b. Knowledge of Subject 1	b. Knowledge of Subject 2	b. Knowledge of Subject 3	b. Knowledge of Subject 4	b. Knowledge of Subject 5
c. Quality of Material	c. Quality of Material 1	c. Quality of Material 2	c. Quality of Material 3	c. Quality of Material 4	c. Quality of Material 5
d. Practical applicability or relevance of topic	d. Practical applicability or relevance of topic 1	d. Practical applicability or relevance of topic 2	d. Practical applicability or relevance of topic 3	d. Practical applicability or relevance of topic 4	d. Practical applicability or relevance of topic 5

a. Presentation Style

a. Presentation Style 1

a. Presentation Style 2

a. Presentation Style 3

a. Presentation Style 4

a. Presentation Style 5

b. Knowledge of Subject

b. Knowledge of Subject 1

b. Knowledge of Subject 2

b. Knowledge of Subject 3

b. Knowledge of Subject 4

b. Knowledge of Subject 5

c. Quality of Material

c. Quality of Material 1

c. Quality of Material 2

c. Quality of Material 3

c. Quality of Material 4

c. Quality of Material 5

d. Practical applicability or relevance of topic

d. Practical applicability or relevance of topic 1

d. Practical applicability or relevance of topic 2

d. Practical applicability or relevance of topic 3

d. Practical applicability or relevance of topic 4

d. Practical applicability or relevance of topic 5

Highly not effective

Highly effective

Highly not effective

Highly effective

Highly not effective

Highly effective

Highly not effective

Highly effective

Program Evaluation

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* 1. Please rate the relationship of content to stated learning objectives:

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* 2. Please rate the effectiveness of the presenter

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* 3. Effectiveness of teaching strategies

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* 4. Effectiveness of technology

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* 5. What are the most significant things you learned in the module?

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* 6. In your work with older adults, do you intend to implement at least one practice improvement learned as a result of this module

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* 7. Please provide any other additional comments, suggestions or questions here

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* 8. Are you interested in receiving continuing education credit?

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* 9. If yes, what type of continuing education credit are you interested in?

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* 10. Please enter your information (below) so we may send you a certificate