Joint Provider- Participant Evaluation Please fill out the program evaluation as, your candid and thorough completion of this evaluation will aid Vassar Brothers Continuing Medical Education in continually improving the quality of its programs. Question Title * 1. Joint Provider Name: ORMC GHVHS HVHC CMG PHC HQIT HVCP HQMP GME Dutchess County Department of Community & Behavioral Health Other (please specify) Question Title * 2. Event Title: ORMC- Trauma ORMC- Pediatrics ORMC- Grand Rounds GHVHS- Multidisciplinary Tumor Board/Breast Tumor Board HVHC- Vascular Review Series CMG-Pediatric Case Review PHC- Multidisciplinary Tumor board PHC- Multidisciplinary Case Review HQIT- Dragon HQIT- Clinical Information Technology HVCP- NPPA HQMP GME- Faculty Development Series Other (please specify) Question Title * 3. Date of Conference Date / Time Date Time AM/PM - AM PM Question Title * 4. How did you hear about this conference? Colleague Website E-mail Facebook Twitter Other (please specify) Question Title * 5. Please indicate how the information you learned; will be applied to your practice or, help you achieve your desired result. Differential diagnosis Change in treatment or patient care management Change in medication administration and/or management Decision-making for consultation or referral Update current understanding or improve knowledge Understand and apply most current standard of care Performance Improvement (PI) Protocol development or guideline implementation Reduce costs or improve efficiency Improve patient education Knowledge base in preparation for a presentation Reduce length of stay Other (please specify) Question Title * 6. Was potential faculty conflict-of-interest (disclosure) conveyed to the audience prior to the activity? Yes No Question Title * 7. Did you perceive any conflict of interest in the presentations? If so, what? No Yes (please specify): Question Title * 8. Please evaluate whether or not the presenters did the following: Yes No Related content to relevant medical practice? Related content to relevant medical practice? Yes Related content to relevant medical practice? No Stimulated my desire to learn? Stimulated my desire to learn? Yes Stimulated my desire to learn? No Held my attention? Held my attention? Yes Held my attention? No Used AV in a helpful manner? Used AV in a helpful manner? Yes Used AV in a helpful manner? No Question Title * 9. In what ways could the presenters improve? Question Title * 10. Were there technical difficulties? No Yes ----> Question Title * 11. If yes, did they affect your ability to do the following?: Yes No See See Yes See No Hear Hear Yes Hear No Learn Learn Yes Learn No Question Title * 12. Comments & Suggestion for future activities: Question Title * 13. Please provide your name and contact information, so that we may contact you if we have any questions regarding your responses. (This information is not required) Name: Title: Email Address: Specialty: Done