Inspire CE Program Evaluation Survey

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* 1. Your Information

Full Name and Credentials (as will be printed on certificate of completion!)

Email (please use a PERSONAL email - this is where certificates will be sent, and healthcare firewalls can cause them to go astray!)

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* 2. Credentials:

RN/BSN/Nursing

Respiratory Therapy

RPSGT

Other or Multiple (please specify)

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* 3. Which course did you complete?

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* 4. On what day was the course presented?

Date

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* 5. Who presented the course?

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* 6. On a scale of 1-4, 1 being low and 4 being high, please indicate how satisfied you were with our continuing education offering on the following parameters:

	1 (Dissatisfied, Strongly Disagree)	2 (Needs Improvement, Disagree)	3 (Satisfied, Agree)	4 (Very Satisfied, Strongly Agree)
Faculty was knowledgeable and effective	Faculty was knowledgeable and effective 1 (Dissatisfied, Strongly Disagree)	Faculty was knowledgeable and effective 2 (Needs Improvement, Disagree)	Faculty was knowledgeable and effective 3 (Satisfied, Agree)	Faculty was knowledgeable and effective 4 (Very Satisfied, Strongly Agree)
Format was appropriate for the subject matter	Format was appropriate for the subject matter 1 (Dissatisfied, Strongly Disagree)	Format was appropriate for the subject matter 2 (Needs Improvement, Disagree)	Format was appropriate for the subject matter 3 (Satisfied, Agree)	Format was appropriate for the subject matter 4 (Very Satisfied, Strongly Agree)
Activity supported achievement of each of the learning objectives	Activity supported achievement of each of the learning objectives 1 (Dissatisfied, Strongly Disagree)	Activity supported achievement of each of the learning objectives 2 (Needs Improvement, Disagree)	Activity supported achievement of each of the learning objectives 3 (Satisfied, Agree)	Activity supported achievement of each of the learning objectives 4 (Very Satisfied, Strongly Agree)
Material was organized clearly for learning to occur	Material was organized clearly for learning to occur 1 (Dissatisfied, Strongly Disagree)	Material was organized clearly for learning to occur 2 (Needs Improvement, Disagree)	Material was organized clearly for learning to occur 3 (Satisfied, Agree)	Material was organized clearly for learning to occur 4 (Very Satisfied, Strongly Agree)
Content learned from this activity will impact my practice	Content learned from this activity will impact my practice 1 (Dissatisfied, Strongly Disagree)	Content learned from this activity will impact my practice 2 (Needs Improvement, Disagree)	Content learned from this activity will impact my practice 3 (Satisfied, Agree)	Content learned from this activity will impact my practice 4 (Very Satisfied, Strongly Agree)
Activity was presented objectively and was free of commercial bias	Activity was presented objectively and was free of commercial bias 1 (Dissatisfied, Strongly Disagree)	Activity was presented objectively and was free of commercial bias 2 (Needs Improvement, Disagree)	Activity was presented objectively and was free of commercial bias 3 (Satisfied, Agree)	Activity was presented objectively and was free of commercial bias 4 (Very Satisfied, Strongly Agree)
I would recommend this activity to others	I would recommend this activity to others 1 (Dissatisfied, Strongly Disagree)	I would recommend this activity to others 2 (Needs Improvement, Disagree)	I would recommend this activity to others 3 (Satisfied, Agree)	I would recommend this activity to others 4 (Very Satisfied, Strongly Agree)

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* 7. This activity will assist in the improvement of my:

Competence

Performance

Patient Outcomes

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* 8. I plan to make the following changes to my practice:

Modify treatment plans

Change my screening / prevention practice

Incorporate different diagnostic strategies in patient evaluation

Use alternative communication methodologies

None: the activity validated current practice

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* 9. What is your level of commitment to making the changes stated above?

Very committed

Somewhat committed

Not very committed

Do not expect to change practice