1 Start 2 Complete

Identify your profession

Physician

Pharmacist

Nurse

Physician Assistant

Resident/Fellow

Student

Other, please specify:

Identify your profession Other, please specify:

Was this activity free of commercial bias?

Yes

No

If you answered "NO", please specify reason:

Please indicate the extent to which you agree with the following statements:

	Strongly Agree	Agree	Not Sure/Neutral	Disagree	Strongly Disagree
The overall learning objectives for this activity were met.	The overall learning objectives for this activity were met. - Strongly Agree	The overall learning objectives for this activity were met. - Agree	The overall learning objectives for this activity were met. - Not Sure/Neutral	The overall learning objectives for this activity were met. - Disagree	The overall learning objectives for this activity were met. - Strongly Disagree
The speakers communicated clearly and effectively.	The speakers communicated clearly and effectively. - Strongly Agree	The speakers communicated clearly and effectively. - Agree	The speakers communicated clearly and effectively. - Not Sure/Neutral	The speakers communicated clearly and effectively. - Disagree	The speakers communicated clearly and effectively. - Strongly Disagree
Presentations utilized good, practical examples to teach/illustrate its major points.	Presentations utilized good, practical examples to teach/illustrate its major points. - Strongly Agree	Presentations utilized good, practical examples to teach/illustrate its major points. - Agree	Presentations utilized good, practical examples to teach/illustrate its major points. - Not Sure/Neutral	Presentations utilized good, practical examples to teach/illustrate its major points. - Disagree	Presentations utilized good, practical examples to teach/illustrate its major points. - Strongly Disagree
My educational expectations for participating in this activity were fulfilled.	My educational expectations for participating in this activity were fulfilled. - Strongly Agree	My educational expectations for participating in this activity were fulfilled. - Agree	My educational expectations for participating in this activity were fulfilled. - Not Sure/Neutral	My educational expectations for participating in this activity were fulfilled. - Disagree	My educational expectations for participating in this activity were fulfilled. - Strongly Disagree
Based on this experience, I am likely to participate in future programs.	Based on this experience, I am likely to participate in future programs. - Strongly Agree	Based on this experience, I am likely to participate in future programs. - Agree	Based on this experience, I am likely to participate in future programs. - Not Sure/Neutral	Based on this experience, I am likely to participate in future programs. - Disagree	Based on this experience, I am likely to participate in future programs. - Strongly Disagree

Are you considering any practice changes as a result of participating in this activity?

Yes

No

Uncertain

Please provide at least one example:

If you answered "No" to the previous question, why not? (please check all that apply)

Current practice is satisfactory

I disagreed with recommendations made

Not confident enough in my ability to make the needed changes

Lack of an implementation plan

Other, please specify:

If you answered "No" to the previous question, why not? (please check all that apply) Other, please specify:

Do you foresee any barriers implementing ideas from this activity into your practice or daily work?

Yes

No

Please specify what the barriers may be:

Please provide additional comments related to the overall program:

Are there any topics that you would like to see covered in future educational activities?

Leave this field blank