TEMPLATE
RSS ACTIVITY NAME
(Grand Rounds, Case Presentation, Journal Club)
EVALUATION
Your comments are essential for improving the effectiveness of KSOM continuing medical education activities. Thank you for completing this evaluation.
Topic: ______________________________ Date: ________ RSS#: _________
Presenter(s): (list names and titles)
Objectives: Following participation in this activity, participants should be able to:
List specific lecture objectives for specific presenter (grand rounds)
Or
List global learning objectives for case conferences and journal clubs
Please indicate to what degree you support the following statements by circling one of the following:
(1-Strongly disagree; 2-Disagree; 3-Undecided; 4-Agree; 5-Strongly agree)
Disagree Agree
This activity met the stated objectives 1 2 3 4 5
The activity’s format was appropriate for the topic 1 2 3 4 5
The activity was relevant to my practice 1 2 3 4 5
The activity was free from commercial bias 1 2 3 4 5
Please rate the overall impact of this educational activity on your professional:
Poor Fair Good Very Good Excellent
a. knowledge 1 2 3 4 5
b. competence 1 2 3 4 5
c. performance 1 2 3 4 5
d. patient care outcomes 1 2 3 4 5
Please estimate the likelihood that you will make changes in your practice setting as a result of this CME activity:
Not at All Unlikely Somewhat Likely Highly Likely Definitely
1 2 3 4 5
Please list changes in your practice you intend to make as a result of participating in this CME activity.
1. ________________________________________________________________________________________
2. ________________________________________________________________________________________
Which of the following competency areas do you feel have been improved as a result of this activity? (Mark all that apply).
___ Patient care or patient-centered care ___ System-based practice
___ Interpersonal and communication skills ___ Interdisciplinary teams
___ Practice-based learning & improvement ___ Quality improvement
___ Professionalism ___ Utilize informatics
___ Employ evidence-based practice
Suggestions for future topics:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
I am a : ___ USC Faculty ___ Fellow ___ Resident ___ Other
FY 2014-15 Rev: 06/2012