1 2 3 4 Did this activity: * CompletelySufficientlyNeutralInsufficientlyNot at All Meet the stated learning objectives? Meet the stated learning objectives? - Completely Meet the stated learning objectives? - Sufficiently Meet the stated learning objectives? - Neutral Meet the stated learning objectives? - Insufficiently Meet the stated learning objectives? - Not at All Address the competencies/attributes relevant to your specialty? Address the competencies/attributes relevant to your specialty? - Completely Address the competencies/attributes relevant to your specialty? - Sufficiently Address the competencies/attributes relevant to your specialty? - Neutral Address the competencies/attributes relevant to your specialty? - Insufficiently Address the competencies/attributes relevant to your specialty? - Not at All Equip you with new information to overcome barriers to treatment? Equip you with new information to overcome barriers to treatment? - Completely Equip you with new information to overcome barriers to treatment? - Sufficiently Equip you with new information to overcome barriers to treatment? - Neutral Equip you with new information to overcome barriers to treatment? - Insufficiently Equip you with new information to overcome barriers to treatment? - Not at All Present the material in a format appropriate to the topic? Present the material in a format appropriate to the topic? - Completely Present the material in a format appropriate to the topic? - Sufficiently Present the material in a format appropriate to the topic? - Neutral Present the material in a format appropriate to the topic? - Insufficiently Present the material in a format appropriate to the topic? - Not at All I expect that my participation in this activity will improve my: * CompletelySufficientlyNeutralInsufficientlyNot at All Competence (skills/abilities/strategies gained from the new information) Competence (skills/abilities/strategies gained from the new information) - Completely Competence (skills/abilities/strategies gained from the new information) - Sufficiently Competence (skills/abilities/strategies gained from the new information) - Neutral Competence (skills/abilities/strategies gained from the new information) - Insufficiently Competence (skills/abilities/strategies gained from the new information) - Not at All Performance (implementing the new skills/abilities/strategies) Performance (implementing the new skills/abilities/strategies) - Completely Performance (implementing the new skills/abilities/strategies) - Sufficiently Performance (implementing the new skills/abilities/strategies) - Neutral Performance (implementing the new skills/abilities/strategies) - Insufficiently Performance (implementing the new skills/abilities/strategies) - Not at All Patient Outcomes (the potential affect from gained skills/abilities/strategies) Patient Outcomes (the potential affect from gained skills/abilities/strategies) - Completely Patient Outcomes (the potential affect from gained skills/abilities/strategies) - Sufficiently Patient Outcomes (the potential affect from gained skills/abilities/strategies) - Neutral Patient Outcomes (the potential affect from gained skills/abilities/strategies) - Insufficiently Patient Outcomes (the potential affect from gained skills/abilities/strategies) - Not at All Please rate the following: * CompletelySufficientlyNeutralInsufficientlyNot at All I would recommend this activity to others. I would recommend this activity to others. - Completely I would recommend this activity to others. - Sufficiently I would recommend this activity to others. - Neutral I would recommend this activity to others. - Insufficiently I would recommend this activity to others. - Not at All The instructional effectiveness and expertise of the faculty were excellent. The instructional effectiveness and expertise of the faculty were excellent. - Completely The instructional effectiveness and expertise of the faculty were excellent. - Sufficiently The instructional effectiveness and expertise of the faculty were excellent. - Neutral The instructional effectiveness and expertise of the faculty were excellent. - Insufficiently The instructional effectiveness and expertise of the faculty were excellent. - Not at All The learning format was appropriate for this activity. The learning format was appropriate for this activity. - Completely The learning format was appropriate for this activity. - Sufficiently The learning format was appropriate for this activity. - Neutral The learning format was appropriate for this activity. - Insufficiently The learning format was appropriate for this activity. - Not at All Based upon your participation in this activity, do you intend to change your practice behavior? * I plan to implement changes in my practice based on the information presented. My current practice is consistent with the information presented. I need more information before I will change my practice. Please describe the change you will implement. * If you plan to change your practice behavior, what type of changes do you plan to implement? (Please select all that apply.) * Apply latest guidelines Choice of treatment/management approach Change in pharmaceutical therapy Change in current practice for referral Change in non-pharmaceutical therapy Change in differential diagnosis Change in diagnostic testing Other If you plan to change your practice behavior, what type of changes do you plan to implement? (Please select all that apply.) Other Are there any barriers or problems that might prevent you from implementing changes in your practice? Please select all that apply. * No Barriers Lack of evidence-based guidelines Lack of practice/patient based guidelines Organizational/institutional barriers Limited time Insurance/financial Increased workload Lack of patient adherence/compliance Other (please indicate below) Are there any barriers or problems that might prevent you from implementing changes in your practice? Please select all that apply. Other (please indicate below) How would you improve this educational activity? (Select all that apply) * No improvements needed Provide better information in advance (ex. directions, activity overview, technical information, etc.) Reduce the amount of content covered Increase the amount of content covered Update the content covered Improve the instructional methods Make the content less difficult Make the content more difficult Slow down the pace of the activity Speed up the pace of the activity Allot more time for the activity Shorten the time allocated for the activity Offer the activity at a different time of the day (Please specify below) Offer the activity at a different time of the year (Please specify below) Other (please specify): How would you improve this educational activity? (Select all that apply) Other (please specify): Time of Day/Year: Leave this field blank
