MOD Awareness to Action: Dismantling Bias in Maternal and Infant Healthcare - October 18, 2022
How would you like your name to appear on your certificate?
Profession
Select Your Profession
Certified Nurse-Midwife
Childbirth Educator
Clinical Nurse Specialist
Community Health Worker
Doula
Nurse Practitioner
Other
Pharmacist
Physician
Registered Nurse
Resident Physician
Social Worker
Student
Next
How many credit hours did you complete?
Credit Hours (maximum: 3.5)
Agreement
By completing this form, you attest that you have attended the number of hours you have indicated above.
I agree
Previous
Next
Organization name:
Previous
Next
Organization city:
Previous
Next
Organization state:
Previous
Next
Have you participated in any other bias training(s) prior to this date?
Yes
No
Previous
Next
Work/Volunteer setting:
Hospital
Clinic
Public Health/Community Settings
Private Practice
Academic Institution
Other
Previous
Next
Please tell us if we met the following objectives:
Understand and be able to identify implicit bias, the cognitive basis that informs bias, and its impact on maternity care settings.
Met
Not Met
Explain how structural racism has played a key role in shaping care settings within the U.S. and contributes to implicit biases in patient/provider encounters.
Met
Not Met
Recognize ones potential for implicit bias and apply strategiies, such as the CARES Framework
TM
and practice cultural humility, to effectively mitigate their own implicit biases.
Met
Not Met
Recognize and establish a culture of equity as an organizational committment to elevate the quality of maternity care.
Met
Not Met
Previous
Next
Was the educational content scientifically sound?
Yes
No
Previous
Next
If no, please explain...
Previous
Next
Was the educational content of value to you?
Very Valuable
Average
Waste of time
Previous
Next
Did this activity improve your competence or performance?Â
Yes
No
Previous
Next
If yes, how...
Previous
Next
What did you learn that will help you in your practice?
Previous
Next
Please respond to the following statements:
This educational activity helped address a gap in my knowledge.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
This activity changed my opinion/attitude about bias.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
If not, please explain why.
One change I am willing to make/action I am liekly to take as a result of this educational activity is:
How would you rate the overall quality of this activity?
Excellent
Very Good
Good
Fair
Poor
Do you have any recommendations on how this activity can be improved?
The facilitator met or exceeded my expectations.
Please list any additional topics that would be of value to you.
Previous
Next
Did you perceive any commercial bias or influence in the educational content?
Yes
No
Previous
Next
If yes, please explain...
Previous
Next
Additional comments/questions/feedback:
Previous
Next
Would you be willing to be contacted for a follow-up evaluation?
Yes
No
Previous