How would you like your name to appear on your certificate?

Profession

How many credit hours did you complete?

Credit Hours (maximum: 1.0)

Agreement

By completing this form, you attest that you have attended the number of hours you have indicated above.

I agree

What Institute/Organization are you with?

What country do you practice in?

Was the educational content of value to you?

Very Valuable

Average

Not Valuable

Was the educational content scientifically sound?

Yes

No

If no, please explain...

Did you perceive any commercial bias or influence in the educational content?

Yes

No

If yes, please explain...

Did this program improve your Skill or Strategy in your role or contribution as a member of the healthcare team?

Yes

No

If no, why not?

Do you believe your participation in this activity will positively impact your healthcare team?

Yes

No

If yes, how?

If no, why not?

Tell us how well or poorly we met any of the educational objectives

Do you think what you learned will benefit you in your practice?

Yes

No

If yes, how...

Tell us what was good or bad about any part of the educational activity, content, speakers, materials, anything.

What questions are you having in your practice that you would like to see addressed in an educational activity?

As a result of this activity, I plan to make the following changes in my practice...

Create/revise protocols, policies and/or procedures

Change the management and/or treatment of my patients

Refer patients to the appropriate clinical trials

Collaborate differently with the healthcare team

None: The activity validated my current practice

Other

What are the perceived barriers in implementing these changes?