Ada Canyon Medical Education Consortium

Ada Canyon Medical Education Consortium

CONTINUING MEDICAL EDUCATION YEAR-END EVALUATION

Conference/Series Title:

* Denotes required questions for ACCME accreditation/reporting.

1. Please indicate your profession: MD/DO NP PA PharmD/RPh RN Other:

2. Overall, how would you rate this educational series?(circle one) Excellent | Very Good | Good | Fair | Poor

3. Which of the following areas of your practice do you feel this series has increased, improved or positively impacted?* (Check all that apply) Knowledge Competence Performance Patient Outcomes

4. Which of the following competency areas do you feel have been addressed by this series?* (Check all that apply)

Patient care or patient-centered care

Medical knowledge

Practice-based learning improvement

Interpersonal communication skills

Professionalism

System-based practice

Interdisciplinary teams

Employ evidence-based practice

Quality improvement

Utilize informatics

None of the above

5. Do you feel this series is evidence-based, balanced and free of commercial bias or influence?* Yes No

IF NO, PLEASE EXPLAIN:

6. As a result of participating in this series, how will you change your practice?* (Check all that apply)

Create/revise protocols, policies, and/or procedures

EXPLAIN:

Change the management and/or treatment of my patients

EXPLAIN:

Other

PLEASE SPECIFY:

This series validated my current practice; no changes will be made

7. Does the series have practical application for your professional needs? Yes No Retired

IF NO AND ACTIVELY PRACTICING, PLEASE EXPLAIN:

8. Over the course of the series, were recommended improvements made to the series that resulted in a better educational experience? Yes No NO IMPROVEMENTS NEEDED

IF YES OR NO, PLEASE EXPLAIN:

9. Over the course of the series, was there an attempt to address identified or perceived barriers to applying information learned in this series into practice? Yes No NO PERCEIVED BARRIERS

IF YES OR NO, PLEASE EXPLAIN:

10. How could this series be improved?

11. Based on your educational needs, what topics you would like to see addressed in future educational activities?

Other comments: