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1. Indicate how well this CME activity met each of the stated learning objectives by checking the box that best describes your answer.
Learning Objective:
Participants will (be able to)Did Not Meet at allMostly UnmetNeither Unmet nor MetMostly MetCompletely Meta. Learning Objective 1b. Learning Objective 2c. Learning Objective 3
1b. Please provide any comments in support of your ratings of the Learning Objectives:
2. Please provide any feedback (favorable comments or constructive criticism) for the speaker:
1. Indicate how well this CME activity met each of the stated learning objectives by checking the box that best describes your answer.
Learning ObjectiveDid Not Meet at allMostly UnmetNeither Unmet nor MetMostly MetCompletely Meta. Learning Objective 1b. Learning Objective 2c. Learning Objective 3
1b. Please provide any comments in support of your ratings of the Learning Objectives:
2. Please provide any feedback (favorable comments or constructive criticism) for the speaker:
Overall Conference Evaluation
3. Please describe what you found most effective about the session:
4. Please describe what you recommend we change about the session:
5. Was this activity fair, balanced, and free from bias?YesNo
5a. If no, please explain:
6. As a result of this session, please describe what, if any, professional behavior you plan on changing:
7. What potential barriers do you anticipate in making such professional behavior changes (i.e., cost, lack of opportunity or resources, reimbursement/insurance issues, etc.)?
8. Please describe how you will address each of the barriers you have identified.
Please Complete: Essential for Reaccreditation Please tell us:
9. What area of your professional activity (teaching, clinical, research, etc.) would you like future educational programs to address? And
10. Why would you like to hear more about this area (e.g., newer treatments available, unaware of current guidelines, lack of training, etc)?
Name of Participant Evaluating Activity*: ________________________________________
(Please print legibly)
(*Required to receive CME credit and/or certificate)
Thank you!
Rev June 2015
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