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April 9-11, 2015 – Houston, TX, USA
OVERALL EVALUATION FORM

SRS respects and appreciate your opinions. To assist us in evaluating the effectiveness of this activity and to make recommendations for future educational offerings, please take a few minutes to complete this evaluation form.

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* 1. Extent to Which Program Activities Met the Identified Objectives
After completing this activity, participants should be able to:

	Outstanding	Good	Satisfactory	Fair	Poor
Identify appropriate options for cervical and adult deformity reconstruction	Identify appropriate options for cervical and adult deformity reconstruction Outstanding	Identify appropriate options for cervical and adult deformity reconstruction Good	Identify appropriate options for cervical and adult deformity reconstruction Satisfactory	Identify appropriate options for cervical and adult deformity reconstruction Fair	Identify appropriate options for cervical and adult deformity reconstruction Poor
Employ techniques to avoid complications in spinal deformity surgery	Employ techniques to avoid complications in spinal deformity surgery Outstanding	Employ techniques to avoid complications in spinal deformity surgery Good	Employ techniques to avoid complications in spinal deformity surgery Satisfactory	Employ techniques to avoid complications in spinal deformity surgery Fair	Employ techniques to avoid complications in spinal deformity surgery Poor
Develop skills in complex cervical deformity correction	Develop skills in complex cervical deformity correction Outstanding	Develop skills in complex cervical deformity correction Good	Develop skills in complex cervical deformity correction Satisfactory	Develop skills in complex cervical deformity correction Fair	Develop skills in complex cervical deformity correction Poor
Identify the appropriate indications for use of spinopelvic instrumentation	Identify the appropriate indications for use of spinopelvic instrumentation Outstanding	Identify the appropriate indications for use of spinopelvic instrumentation Good	Identify the appropriate indications for use of spinopelvic instrumentation Satisfactory	Identify the appropriate indications for use of spinopelvic instrumentation Fair	Identify the appropriate indications for use of spinopelvic instrumentation Poor
Demonstrate skills for the correct placement of spinopelvic instrumentation	Demonstrate skills for the correct placement of spinopelvic instrumentation Outstanding	Demonstrate skills for the correct placement of spinopelvic instrumentation Good	Demonstrate skills for the correct placement of spinopelvic instrumentation Satisfactory	Demonstrate skills for the correct placement of spinopelvic instrumentation Fair	Demonstrate skills for the correct placement of spinopelvic instrumentation Poor
Compare and contrast open and less invasive treatment options for thoracolumbar spinal deformity	Compare and contrast open and less invasive treatment options for thoracolumbar spinal deformity Outstanding	Compare and contrast open and less invasive treatment options for thoracolumbar spinal deformity Good	Compare and contrast open and less invasive treatment options for thoracolumbar spinal deformity Satisfactory	Compare and contrast open and less invasive treatment options for thoracolumbar spinal deformity Fair	Compare and contrast open and less invasive treatment options for thoracolumbar spinal deformity Poor
Integrate techniques for posterior and anterior lumbosacral deformity corrections	Integrate techniques for posterior and anterior lumbosacral deformity corrections Outstanding	Integrate techniques for posterior and anterior lumbosacral deformity corrections Good	Integrate techniques for posterior and anterior lumbosacral deformity corrections Satisfactory	Integrate techniques for posterior and anterior lumbosacral deformity corrections Fair	Integrate techniques for posterior and anterior lumbosacral deformity corrections Poor
Demonstrate knowledge and skills for performing basic and complex spinal osteotomies for spinal deformity correction	Demonstrate knowledge and skills for performing basic and complex spinal osteotomies for spinal deformity correction Outstanding	Demonstrate knowledge and skills for performing basic and complex spinal osteotomies for spinal deformity correction Good	Demonstrate knowledge and skills for performing basic and complex spinal osteotomies for spinal deformity correction Satisfactory	Demonstrate knowledge and skills for performing basic and complex spinal osteotomies for spinal deformity correction Fair	Demonstrate knowledge and skills for performing basic and complex spinal osteotomies for spinal deformity correction Poor

Question Title

* 2. Effectiveness of the CME content

	Outstanding	Good	Satisfactory	Fair	Poor
Objectives were related to overall purpose/goal(s) of activity.	Objectives were related to overall purpose/goal(s) of activity. Outstanding	Objectives were related to overall purpose/goal(s) of activity. Good	Objectives were related to overall purpose/goal(s) of activity. Satisfactory	Objectives were related to overall purpose/goal(s) of activity. Fair	Objectives were related to overall purpose/goal(s) of activity. Poor
Enhanced my current knowledge base.	Enhanced my current knowledge base. Outstanding	Enhanced my current knowledge base. Good	Enhanced my current knowledge base. Satisfactory	Enhanced my current knowledge base. Fair	Enhanced my current knowledge base. Poor
Will help me improve patient care.	Will help me improve patient care. Outstanding	Will help me improve patient care. Good	Will help me improve patient care. Satisfactory	Will help me improve patient care. Fair	Will help me improve patient care. Poor
Provided new ideas or information I expect to use.	Provided new ideas or information I expect to use. Outstanding	Provided new ideas or information I expect to use. Good	Provided new ideas or information I expect to use. Satisfactory	Provided new ideas or information I expect to use. Fair	Provided new ideas or information I expect to use. Poor
Was timely and will influence my practice of medicine.	Was timely and will influence my practice of medicine. Outstanding	Was timely and will influence my practice of medicine. Good	Was timely and will influence my practice of medicine. Satisfactory	Was timely and will influence my practice of medicine. Fair	Was timely and will influence my practice of medicine. Poor
Addressed my most pressing questions.	Addressed my most pressing questions. Outstanding	Addressed my most pressing questions. Good	Addressed my most pressing questions. Satisfactory	Addressed my most pressing questions. Fair	Addressed my most pressing questions. Poor
Was free from commercial bias or influence	Was free from commercial bias or influence Outstanding	Was free from commercial bias or influence Good	Was free from commercial bias or influence Satisfactory	Was free from commercial bias or influence Fair	Was free from commercial bias or influence Poor

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* 3. If the content was NOT free from commercial bias or influence, please explain why:

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* 4. How could the effectiveness of this CME activity be improved?:

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* 5. Please indicate any changes you plan to make in your practice of medicine as a result of information you received from this activity:

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* 6. In what time frame do you anticipate making these changes?

Immediately

1 -2 months

3 -6 months

At some point in the future

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* 7. Based on my participation in this CME activity, I will now incorporate the following new clinical strategies (check all that apply):

Consistently select surgical and non-surgical interventions based on a thoughtful review of current indications and contraindications for various spinal pathologies.

Carefully consider documented benefits versus known potential complications in the treatment of various pathologies.

Develop consistent treatment plans for particular problems to achieve more predictable results

I already do all these things

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* 8. If you do not plan to incorporate the above clinical strategies, please list any factors that will prevent you from doing so:

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* 9. Would more information on the following subjects help to improve your care of patients?

	Absolutely	To some extent	Not at all
Emerging technology	Emerging technology Absolutely	Emerging technology To some extent	Emerging technology Not at all
Pre-operative planning	Pre-operative planning Absolutely	Pre-operative planning To some extent	Pre-operative planning Not at all
Outcomes	Outcomes Absolutely	Outcomes To some extent	Outcomes Not at all
Complications	Complications Absolutely	Complications To some extent	Complications Not at all
Instrumentation	Instrumentation Absolutely	Instrumentation To some extent	Instrumentation Not at all
Surgical approaches	Surgical approaches Absolutely	Surgical approaches To some extent	Surgical approaches Not at all
Non-operative management	Non-operative management Absolutely	Non-operative management To some extent	Non-operative management Not at all
Biologic options	Biologic options Absolutely	Biologic options To some extent	Biologic options Not at all
Other*	Other* Absolutely	Other* To some extent	Other* Not at all

*please specify

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* 10. Please rate the effectiveness of the following presentation formats:

	Very effective	Somewhat effective	Not at all effective
Fireside Chats	Fireside Chats Very effective	Fireside Chats Somewhat effective	Fireside Chats Not at all effective
Lectures	Lectures Very effective	Lectures Somewhat effective	Lectures Not at all effective
Technique Discussions	Technique Discussions Very effective	Technique Discussions Somewhat effective	Technique Discussions Not at all effective
Video Demonstrations	Video Demonstrations Very effective	Video Demonstrations Somewhat effective	Video Demonstrations Not at all effective
Hands-On Sessions	Hands-On Sessions Very effective	Hands-On Sessions Somewhat effective	Hands-On Sessions Not at all effective

Comments:

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* 11. Please provide general comments regarding this activity and suggest how it might be improved:

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* 12. This activity was designed to help the participant master the ABMS/ACGME core competency of patient care and medical knowledge. How well did this activity address this competency?

Outstanding

Good

Satisfactory

Fair

Poor

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* 1. Extent to Which Program Activities Met the Identified ObjectivesAfter completing this activity, participants should be able to:

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* 2. Effectiveness of the CME content

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* 3. If the content was NOT free from commercial bias or influence, please explain why:

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* 4. How could the effectiveness of this CME activity be improved?:

Question Title

* 5. Please indicate any changes you plan to make in your practice of medicine as a result of information you received from this activity:

Question Title

* 6. In what time frame do you anticipate making these changes?

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* 7. Based on my participation in this CME activity, I will now incorporate the following new clinical strategies (check all that apply):

Question Title

* 8. If you do not plan to incorporate the above clinical strategies, please list any factors that will prevent you from doing so:

Question Title

* 9. Would more information on the following subjects help to improve your care of patients?

Question Title

* 10. Please rate the effectiveness of the following presentation formats:

Question Title

* 11. Please provide general comments regarding this activity and suggest how it might be improved:

Question Title

* 12. This activity was designed to help the participant master the ABMS/ACGME core competency of patient care and medical knowledge. How well did this activity address this competency?

* 1. Extent to Which Program Activities Met the Identified Objectives
After completing this activity, participants should be able to: