Topic and Presenter
Rating scale
Excellent
Very Good
Good
Fair
Poor
Presenting Skills
Practical Value/Content
Areas to Improve
Strengths
Were evidence-based references incorporated when appropriate?
Yes
No
If No, please explain
This activity was free of commercial bias* or influence. * * Commercial bias is defined as a personal judgment in favor of a specific product or service of a commercial interest.
Yes
No
If No, please explain
The content of this activity matched my current or potential scope of practice.
Yes
No
If No, please explain
Rate how much this activity improved your:
Extremely High
High
Medium
Low
Very Low
Knowledge (Obtained new knowledge that I did not know before)
Competence (Obtained knowledge-in-action, skills or attitudes)
Performance (Obtained skills, abilities or strategies that I plan to implement/apply to improve my practice)
Patient Outcomes (Obtained strategies that I will use to improve patient care and thereby improve patient outcomes)
Team Performance (Obtained skills, abilities, actions, strategies, etc. that will benefit the healthcare team in which I am a member)
Describe how this activity improved your: (Select all that apply)
Knowledge (What have you learned that you did not know before?)
Competence (What knowledge-in-action, skills or attitude have you gained?)
Performance (What skills, abilities or strategies do you plan to implement/apply to improve your practice?)
Patient Outcomes (Identify one or more strategies you will use to improve patient care and thereby improve patient outcomes?)
Team Performance (Describe any skills, abilities, actions, strategies, etc. that will benefit your healthcare team in which you are a member)
Description:
Identify the types/sources of barriers this activity will help you overcome in order to implement changes to practice: (Select all that apply)
Formulary restrictions
Patient compliance
Reimbursement/Insurance issues
Lack of time to assess/counsel patients
Lack of appropriate resources, tools, or equipment
Lack of support from organizational leadership
Organizational policies
Guidelines are too complex
Guidelines limit flexibility and individual treatment options
Guidelines are not easily accessible
Lack of specialists to refer patients to when necessary
Other
If Other, please describe:
The format of this educational activity can be improved by : (select all that apply)
Format was appropriate; no changes needed
Include more case-based presentations
Increase interactivity with participants
Add breakouts for subtopics
Add a hands-on instructional component
Incorporate time for question & answer
Other
If Other, please describe:
Provide additional comments related to this activity:
I would recommend this activity to others:
Yes
No
If No, Please Explain:
Based on my educational needs, I would like to see the following topics addressed in future educational activities: