ACTIVITY EVALUATION – LIVE ACTIVITY
Your comments are essential for improving the effectiveness of UCSF’s continuing medical education activities. Thank you for completing this questionnaire.
Activity Title: / Course Number:- How did you learn about this course? (Circle all that apply)
a) Previous attendanceat this course / c) UCSF e-mail / e) Other internet source / g) Brochure
b) Previous attendance at other UCSFcourse / d) UCSF CME website / f) Save-the-Date card / h) Word-of-mouth/colleague
2. Degree(s) (please indicate):
3. If a physician, what is your specialty?
4. First year entered practice? Most Recent Board Certification
5. Did you stay at the hotel? YES NO
If “NO,” please explain why:
6. Please evaluate the following aspects of this course:
Pre-Course Registration Process/Staff AssistancePoor / Fair / Good / Very Good / Excellent
1 2 3 4 5
Quality of Course Information on CME Website
Poor / Fair / Good / Very Good / Excellent
1 2 3 4 5
Onsite Course Organization/Staff AssistancePoor / Fair / Good / Very Good / Excellent
1 2 3 4 5
Audio Visual Services
Poor / Fair / Good / Very Good / Excellent
1 2 3 4 5
7. Would you prefer to receive information via:
EmailPostal Mail Both
8. How far in advance do you decide which CME course you will attend?1 Month 3 Months 6 Months 1 Year
9. Please rate the overall impact of this educational activity on your:
Poor / Fair / Good / Very Good / Excellenta. Competence 1 2 3 4 5
b. Performance 1 2 3 4 5
c. Patient Care Processes 1 2 3 4 5
10. Please ratethe impact of each objective on your professional competence, performance and patient care outcomes on a scale of 1 to 5 (1-poor, 5-excellent):
Educational Objective 1 PoorFair Good Very Good Excellent
a.Competence1 2 3 4 5
b. Performance1 2 3 4 5
c. Patient Outcomes 1 2 3 4 5
Educational Objective 2 PoorFair Good Very Good Excellent
a.Competence1 2 3 4 5
b. Performance1 2 3 4 5
c. Patient Outcomes 1 2 3 4 5
11. Please assess how well this activity met your identified educational needs and practice gaps:
Poor / Fair / Good / Very Good / Excellent1 2 3 4 5
12. Please rate the following aspects of this educational activity:
Poor / Fair / Good / Very Good / Excellenta. Overall quality of activity 1 2 3 4 5
b. Selection of topics 1 2 3 4 5
c. Overall quality of faculty 1 2 3 4 5
d. Activity organization 1 2 3 4 5
e. Questions and discussion 1 2 3 4 5
f. Relevance to practice 1 2 3 4 5
g. Educational content 1 2 3 4 5
- Please estimate the likelihood that you will make changes in the care and management of your patients as a result of this CME activity:
Not At All / Unlikely / Somewhat Likely / Highly Likely / Definitely
1 2 3 4 5
14. Please list three or more specific changesin patient care that you intend to make as a result of participating in this CME activity.
15. Please identify any barriers you perceive in implementing these changes (select all that apply).
Cost
Lack of time to assess/counsel patients
Lack of administrative support/resources
Insurance/Reimbursement issues
Patient compliance issues
Lack of consensus or professional guidelines
Other (describe)
- Do you agree with the following statement: “This course was free of commercial bias?”
Please circle:YESorNO
If “NO,” please explain why:
- Issues in cultural and linguistic competency (e.g. differences in prevalence, diagnosis, treatment in diverse population; linguistic skills; pertinent cultural data) were adequately addressed in this activity.
Please circle:YESorNO
If “NO,” please explain why:
18. Resources on cultural and linguistic competency have been included in your materials. How can we further meet your educational needs in this area?
19. Based on your identified educational needs and/or professional practice gaps, please provide us with suggestions for future program topics and formats.
20. Please provide your email address if we may contact you for a brief follow-up questionnaire.
21. Please rate each speaker as noted below. Please also write any additional constructivesuggestions to aid the speaker in future presentations.
SPEAKER EVALUATION
Title of Lecture 1:
Speaker’s Name:
Poor / Fair / Good / Very Good / Excellenta. Delivery 1 2 3 4 5
b. Content 1 2 3 4 5
c. Syllabus 1 2 3 4 5
d. Practical Value 1 2 3 4 5
Comments:
Title of Lecture 2:
Speaker’s Name:
Poor / Fair / Good / Very Good / Excellenta. Delivery 1 2 3 4 5
b. Content 1 2 3 4 5
c. Syllabus 1 2 3 4 5
d. Practical Value 1 2 3 4 5
Comments:
Thank you!
University of California, San FranciscoSchool of Medicine
Office of Continuing Medical Education
E-mail: