Required Questions
The evaluation must be emailed to the CME department for approval at least two (2) weeks before the activity start date.
Include the following statement: The evaluation results may be sent to the continuing education board.
Question 1
This activity was balanced and free of commercial bias.
- Yes
- No Comments:
Question 2
Did the activity meet your expectations in accomplishing the stated objectives? | Completely | Mostly | Partially | Minimally | Not at All |
---|---|---|---|---|---|
Objective 1 | |||||
Objective 2 | |||||
Objective 3 | |||||
Objective 4 |
Question 3: This educational activity will result in a change in my: (Mark all that apply)
- Knowledge (facts and information acquired by a person through experience or education)
- Competence (having the ability to apply knowledge, skills, or judgment in practice if called upon to do so)
- Performance (what the participant does in practice)
- Patient outcomes (actual outcomes in individual patients and/or patient populations)
- Community (change in population health status)
- This activity did not result in a change.
Question 4: Describe any ‘pearls’ or takeaway messages.
Question 5: Note any changes or improvements in the care of your patients that you plan to make as a result of attending this educational activity. If no changes are identified, please explain why (program format, content not appropriate, nothing learned, etc.).
Question 6: Identify any barriers that you perceive in implementing these changes. Mark all that apply.
DMU note: You can change, add, or delete the barriers below. An open text box is also sufficient.
- No barriers
- Cost
- Lack of experience
- Lack of opportunity/patients
- Lack of resources/equipment
- Lack of administrative support
- Insurance/reimbursement issues
- Lack of consensus or professional guidelines
- Lack of time to assess/counsel patients
- Patient compliance issues
- Not applicable to my practice
- Other:
Question 7: How will you address these barriers to implementing these changes in your practice?
Question 8: Given the scope of your practice, what educational needs do you have?
Question 9: Please provide any additional comments and/or suggestions below.