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

Organization name:

Organization city:

Organization state:

Have you participated in any other bias training(s) prior to this date?

Work/Volunteer setting:

Participant will be able to explain implicit bias, including its cognitive basis and potential impact on maternal care.

Participant will be able to describe how structural racism in the U.S. contributes to implicit bias in maternal care.

Participant will be able to apply an equity lens that takes into consideration patient needs when making decisions.

Participant will be able to use the ALLY Model strategies in patient interactions to avoid implicit bias.

Was the educational content scientifically sound?

If no, please explain...

Was the educational content of value to you?

Did this activity improve your competence or performance? 

If yes, how...

What did you learn that will help you in your practice?

This educational activity helped address a gap in my knowledge.

This activity changed my opinion/attitude about bias.

One change I am willing to make/action I am likely to take as a result of this educational activity is:

How would you rate the overall quality of this activity?

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.

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

If yes, please explain...

Additional comments/questions/feedback:

Would you be willing to be contacted for a follow-up evaluation?