EVALUATION FORM:
Surgical Complications of the Foot and Ankle Course:
November 5-7, 2015: Tampa, Florida
Thursday, November 5
Session One: The Forefoot, Part 1: The First Ray
Excellent / Good / Fair / PoorContent
Presentation
Handout (if applicable)
Value of topic
1. Was the educational value of this presentation compromised by commercial bias?Yes No
If yes, please explain: ______
2. Based on this presentation, will you implement knowledge gained into your practice? Yes No
Very much Good Average Slightly Not at all
3. To what extent did you add to your knowledge?
4. How will you change your patient care as a result of this symposium?
______
5. What are the barriers to implementation in your practice:
______
Session One: The Forefoot, Part 2: The Little Piggies
Content
Presentation
Handout (if applicable)
Value of topic
1. Was the educational value of this presentation compromised by commercial bias?Yes No
If yes, please explain: ______
2. Based on this presentation, will you implement knowledge gained into your practice? Yes No
Very much Good Average Slightly Not at all
3. To what extent did you add to your knowledge?
4. How will you change your patient care as a result of this symposium?
______
5. What are the barriers to implementation in your practice:
______
Session Two: Trauma 1
Content
Presentation
Handout (if applicable)
Value of topic
1. Was the educational value of this presentation compromised by commercial bias?Yes No
If yes, please explain: ______
2. Based on this presentation, will you implement knowledge gained into your practice? Yes No
Very much Good Average Slightly Not at all
3. To what extent did you add to your knowledge?
4. How will you change your patient care as a result of this symposium?
______
5. What are the barriers to implementation in your practice:
______
Friday, November 6
Session Two: Trauma 2
Excellent / Good / Fair / PoorContent
Presentation
Handout (if applicable)
Value of topic
1. Was the educational value of this presentation compromised by commercial bias?Yes No
If yes, please explain: ______
2. Based on this presentation, will you implement knowledge gained into your practice? Yes No
Very much Good Average Slightly Not at all
3. To what extent did you add to your knowledge?
4. How will you change your patient care as a result of this symposium?
______
5. What are the barriers to implementation in your practice:
______
Session Three: Midfoot
Content
Presentation
Handout (if applicable)
Value of topic
1. Was the educational value of this presentation compromised by commercial bias?Yes No
If yes, please explain: ______
2. Based on this presentation, will you implement knowledge gained into your practice? Yes No
Very much Good Average Slightly Not at all
3. To what extent did you add to your knowledge?
4. How will you change your patient care as a result of this symposium?
______
5. What are the barriers to implementation in your practice:
______
Session Four: Sports 1
Excellent / Good / Fair / PoorContent
Presentation
Handout (if applicable)
Value of topic
1. Was the educational value of this presentation compromised by commercial bias?Yes No
If yes, please explain: ______
2. Based on this presentation, will you implement knowledge gained into your practice? Yes No
Very much Good Average Slightly Not at all
3. To what extent did you add to your knowledge?
4. How will you change your patient care as a result of this symposium?
______
5. What are the barriers to implementation in your practice:
______
Session Four: Sports 2
Excellent / Good / Fair / PoorContent
Presentation
Handout (if applicable)
Value of topic
1. Was the educational value of this presentation compromised by commercial bias?Yes No
If yes, please explain: ______
2. Based on this presentation, will you implement knowledge gained into your practice? Yes No
Very much Good Average Slightly Not at all
3. To what extent did you add to your knowledge?
4. How will you change your patient care as a result of this symposium?
______
5. What are the barriers to implementation in your practice:
______
Session Five: Flatfoot
Excellent / Good / Fair / PoorContent
Presentation
Handout (if applicable)
Value of topic
1. Was the educational value of this presentation compromised by commercial bias?Yes No
If yes, please explain: ______
2. Based on this presentation, will you implement knowledge gained into your practice? Yes No
Very much Good Average Slightly Not at all
3. To what extent did you add to your knowledge?
4. How will you change your patient care as a result of this symposium?
______
5. What are the barriers to implementation in your practice:
______
Session Six: Cavovarus Foot
Excellent / Good / Fair / PoorContent
Presentation
Handout (if applicable)
Value of topic
1. Was the educational value of this presentation compromised by commercial bias?Yes No
If yes, please explain: ______
2. Based on this presentation, will you implement knowledge gained into your practice? Yes No
Very much Good Average Slightly Not at all
3. To what extent did you add to your knowledge?
4. How will you change your patient care as a result of this symposium?
______
5. What are the barriers to implementation in your practice:
______
Saturday, November 7
Session Seven: Hindfoot Arthrodesis
Excellent / Good / Fair / PoorContent
Presentation
Handout (if applicable)
Value of topic
1. Was the educational value of this presentation compromised by commercial bias?Yes No
If yes, please explain: ______
2. Based on this presentation, will you implement knowledge gained into your practice? Yes No
Very much Good Average Slightly Not at all
3. To what extent did you add to your knowledge?
4. How will you change your patient care as a result of this symposium?
______
5. What are the barriers to implementation in your practice:
______
Session Eight: The Potpourri No One Wants To Talk About …
Excellent / Good / Fair / PoorContent
Presentation
Handout (if applicable)
Value of topic
1. Was the educational value of this presentation compromised by commercial bias?Yes No
If yes, please explain: ______
2. Based on this presentation, will you implement knowledge gained into your practice? Yes No
Very much Good Average Slightly Not at all
3. To what extent did you add to your knowledge?
4. How will you change your patient care as a result of this symposium?
______
5. What are the barriers to implementation in your practice:
______
Session Nine: Your Turn
Excellent / Good / Fair / PoorContent
Presentation
Handout (if applicable)
Value of topic
1. Was the educational value of this presentation compromised by commercial bias?Yes No
If yes, please explain: ______
2. Based on this presentation, will you implement knowledge gained into your practice? Yes No
Very much Good Average Slightly Not at all
3. To what extent did you add to your knowledge?
4. How will you change your patient care as a result of this symposium?
______
5. What are the barriers to implementation in your practice:
______
Session Ten: Total Ankle Arthroplasty
Content
Presentation
Handout (if applicable)
Value of topic
1. Was the educational value of this presentation compromised by commercial bias?Yes No
If yes, please explain: ______
2. Based on this presentation, will you implement knowledge gained into your practice? Yes No
Very much Good Average Slightly Not at all
3. To what extent did you add to your knowledge?
4. How will you change your patient care as a result of this symposium?
______
5. What are the barriers to implementation in your practice:
______
This educational program (check all that apply):
Confirmed that my knowledge in this subject area is up to date
Presented me with new knowledge on the topics
Presented me with new knowledge directly applicable to my practice
Will stimulate me to gain further knowledge on this topic
None of the above.
Future topics to be addressed – What are your perceived practice gaps?
______
______
______
______
What percentage of your practice is foot and ankle surgery?
_____100% _____ 75-100% _____50-75% _____25-50% _____10-25% _____less than 10%
______
(Name, please print)
Please return your completed Evaluation Form to the
AOFAS Registration Desk
Questions or to Contact AOFAS
American Orthopaedic Foot & Ankle Society
9400 W. Higgins Road, Suite 220
Rosemont, IL 60018
Phone: 847-698-4654 or (toll free) 800-235-4855
Fax: 847-692-3315
E-mail:
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