TITLE

Regularly Scheduled SeriesSemi-Annual Evaluation Form
Evaluation Period July – DecemberYEAR January – JuneYEAR

Today’s Date:DATE

Please answer the following questions based on your experience with this educational series during the past six months. / Very
Low / Moderate / Very
High
  1. To what extent were you satisfied with the quality of the presentations in this series?

  1. To what extent were the topics in this series relevant to your professional activities (clinical care, research, and/or teaching)?

  1. To what degree did this series enhance your knowledge of issues related to clinical care, research, and/or teaching?

  1. To what degree did this series enhance your ability to use the biomedical literature and best available evidence to improve your clinical practice/professional responsibilities (clinical care, research, and/or teaching)?

  1. To what degree did this series enhance your ability to provide ethical and culturally sensitive care for your patients or to carry out your other professional responsibilities in an ethical manner?

  1. To what degree did this series enhance your ability to use health care data and other evidence to improve the quality of care that you deliver to your patients or to improve the processes by which you conduct research or education?

  1. To what degree did this series improve your ability to work within theclinical (inpatient and/or outpatient) or academic environment (understanding health care orresearch policy, population health issues, healthcare economics,organizational dynamics, etc.)?

  1. To what degree did the discussions candidly focus on issues that might lead to improvements in the quality of care provided here (medical errors; adverse events; organizational policies, procedures, resource, etc.)?

  1. To what degree was the content of this series scientifically rigorous, unbiased and balanced?

  1. To what degree was the content of this series free of commercial bias?

  1. To what degree did this series provide sufficient opportunity for discussion and interaction among presenters and/or participants?

  1. As a result of your participation in this series, will you adopt a new strategy or modify an existing strategy for managing patients or accomplishing other work that you do?

No YesIf yes, would you share with us what you intend to do differently?

______

  1. What impact will this series have on your interprofessional collaborative practice? (Check all that apply)

Having completed this series, you are better able to:

Work with individuals of other professions to maintain a climate of mutual respect and shared values

Use the knowledge of your own role and those of other professions to appropriately assess and address the health care needs of patients

Communicate with patients, families, and other health professionals in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease

Perform effectively on teams to plan, deliver, and evaluate patient/population-centered care

Other: specify ______

No impact; this series did not address interprofessional collaborative practice

  1. Please provide additional comments pertaining to this series and any suggestions for improvement.
  1. What topics do you want to hear more about, and what issue(s) regarding your clinical practice/professional responsibilities will they address?
  1. Which of the following categories best represents your professional responsibilities?

MD or DO or MD/PhDOther health care professional degree(specify) ______

RN or other nursing degreePhD

PharmD or other pharmacy degreeOther (specify) ______

Please leave this evaluation form at the sign-in desk prior to your departure.

RSS Semi-Annual Evaluation Mar 2018