Live Activity Closing Report Data Collection Question Title * 1. Date of Activity Date / Time Date Question Title * 2. Activity Title Question Title * 3. Name of person completing the Closing Report Question Title * 4. What was the format of your activity? In-Person Virtual Both Question Title * 5. Enter the # of each profession that attended the activity. Physicians Nurses Pharmacists Physician Assistants Dietitians Athletic Trainers Other Healthcare Professionals Question Title * 6. Enter the # of each practice type that attended the activity. Clinical Research Administration Teaching Other Question Title * 7. Enter the # of each practice setting that attended the activity. Private Hospital Community Hospital Private Practice Academic Health Center Other Question Title * 8. Enter the # of each UAMS vs Non-UAMS Employee that attended the activity. UAMS Employee Other Question Title * 9. How many attendees indicated that they are a member of a Heath Care Team? Member of a Health Care Team Not a Member of a Health Care Team Question Title * 10. Total exhibit and advertising income received (put 0 if this course did not have exhibit and advertising income) Question Title * 11. Total registration fees received (put 0 if this course did not have registration fees) Question Title * 12. Total government monetary grants received for this course (put 0 if this course did not have any government monetary grants) Question Title * 13. Total private monetary donations for this course (put 0 if this course did not have any private monetary donations) Question Title * 14. Did this course have commercial support (Commercial support is an educational grant from a pharmaceutical or device manufacturing company. You would have applied for that grant. Put 0 if you did not apply for educational grants from a pharmaceutical or device manufacturing company.)? Yes No Question Title * 15. List each Commercial Supporter and the amount of support. Example: Pfizer, $5000.00. Question Title * 16. Did you provide any non-educational interventions? If so, please check all that apply. Access to Presentation Slides Handouts Patient Reminders Pocket Guidelines for Healthcare Providers Patient Education Materials Links to information on the internet Non-education interventions were not used in this course. Other (please specify) Question Title * 17. Based on an analysis of your evaluation data, how effective was this activity in: Very Effective Effective Neutral Ineffective Very Ineffective Meeting the overall objectives of the event? Meeting the overall objectives of the event? Very Effective Meeting the overall objectives of the event? Effective Meeting the overall objectives of the event? Neutral Meeting the overall objectives of the event? Ineffective Meeting the overall objectives of the event? Very Ineffective Improving the knowledge level of the learners? Improving the knowledge level of the learners? Very Effective Improving the knowledge level of the learners? Effective Improving the knowledge level of the learners? Neutral Improving the knowledge level of the learners? Ineffective Improving the knowledge level of the learners? Very Ineffective Improving the competence level of the learners? Improving the competence level of the learners? Very Effective Improving the competence level of the learners? Effective Improving the competence level of the learners? Neutral Improving the competence level of the learners? Ineffective Improving the competence level of the learners? Very Ineffective Improving the performance of the learners? Improving the performance of the learners? Very Effective Improving the performance of the learners? Effective Improving the performance of the learners? Neutral Improving the performance of the learners? Ineffective Improving the performance of the learners? Very Ineffective Improving patient outcomes? Improving patient outcomes? Very Effective Improving patient outcomes? Effective Improving patient outcomes? Neutral Improving patient outcomes? Ineffective Improving patient outcomes? Very Ineffective Question Title * 18. What actions will you take to improve the effectiveness for changing learner behavior or patient outcomes? Review topics presented and make changes to the agenda Change the educational methods to include more active audience participation Include more case-based presentations Provide learners with strategies to incorporate into their practice, as appropriate. No changes are needed Other (please specify) Question Title * 19. Please indicate how effective the activity was in improving the learner's ability to: Very Effective Effective Neutral Ineffective Very Ineffective Apply the knowledge and/or skills acquired from this activity to their work when in a team environment. Apply the knowledge and/or skills acquired from this activity to their work when in a team environment. Very Effective Apply the knowledge and/or skills acquired from this activity to their work when in a team environment. Effective Apply the knowledge and/or skills acquired from this activity to their work when in a team environment. Neutral Apply the knowledge and/or skills acquired from this activity to their work when in a team environment. Ineffective Apply the knowledge and/or skills acquired from this activity to their work when in a team environment. Very Ineffective Collaborate with a multidisciplinary team. Collaborate with a multidisciplinary team. Very Effective Collaborate with a multidisciplinary team. Effective Collaborate with a multidisciplinary team. Neutral Collaborate with a multidisciplinary team. Ineffective Collaborate with a multidisciplinary team. Very Ineffective Communicate with other members of a multidisciplinary team. Communicate with other members of a multidisciplinary team. Very Effective Communicate with other members of a multidisciplinary team. Effective Communicate with other members of a multidisciplinary team. Neutral Communicate with other members of a multidisciplinary team. Ineffective Communicate with other members of a multidisciplinary team. Very Ineffective Discuss how teamwork can contribute to continuous and reliable patient care. Discuss how teamwork can contribute to continuous and reliable patient care. Very Effective Discuss how teamwork can contribute to continuous and reliable patient care. Effective Discuss how teamwork can contribute to continuous and reliable patient care. Neutral Discuss how teamwork can contribute to continuous and reliable patient care. Ineffective Discuss how teamwork can contribute to continuous and reliable patient care. Very Ineffective Question Title * 20. What barriers did you or your learners identify as potentially preventing their incorporating what they learned in this activity into their work? (select all that apply) Lack of experience Lack of opportunity (Patients) Lack of resources (access to equipment, online materials, funds) Lack of administrative support Lack of time to assess/counsel patients Reimbursement/insurance issues Patient compliance Lack of consensus of professional guidelines No barriers Other (please specify) Question Title * 21. Please indicate ideas you may use to address the identified barriers in future activities (mark all that apply): Include discussion about barriers that the learners may encounter Provide strategies for overcoming the identified barriers Suggest resources learners could refer to when encountering barriers No barriers were identified Other (please specify) Question Title * 22. Based on an analysis of the participants in the activity, to what extent did the activity reach the targeted audience? 90-100% 80-89% 70-79% 60-69% 50-59% Less than 50% of the participants consisted of the target audience. Explanation of "no" answer Question Title * 23. Based on the percentage of targeted audience participating in the activity, how satisfied are you with reaching the targeted audience Very satisfied Satisfied Neither satisfied nor dissatisfied Dissatisfied Very dissatisfied Question Title * 24. To improve reaching the targeted audience which of the options would you plan to use: Change the time of day for the activity Change the frequency of the activity Unsure what to do to improve attendance Target audience was reached, do not plan to make changes Other (please specify) Question Title * 25. Analysis of the evaluations shows that the activity was scientifically sound and free of commercial bias Yes No If no, please explain: Question Title * 26. Analysis of the evaluations show that overall the presentations were balanced, objective and scientifically rigorous. Yes No If no, please explain Question Title * 27. Were any new instructional strategies included in this activity? Yes No If yes, please explain what was tried and how well it was accepted and how effective it was. Question Title * 28. Were there other outcomes or achievements that occured as a result of this activity? Yes No If yes, please describe. Done