ACMS - 2012 Mohs College Annual Meeting
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Agreement
By completing this form, you attest that you have attended the activity in its entirety.
I agree
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Please rate the following:
The program was relevant to my work.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
Content matched stated objectives.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
Usefulness of handouts/AV.
Excellent
Very Good
Good
Fair
Poor
Quality of facilities.
Excellent
Very Good
Good
Fair
Poor
How well did the educational sessions give a balanced view of therapeutic options, including the use of generic names?
Excellent
Very Good
Good
Fair
Poor
If you rated any of the above questions with 'fair,' 'poor,' 'disagree,' or 'strongly disagree' please explain:
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Objective 1: Identify critical anatomic landmarks and structures that impact functional and cosmetic reconstruction of the nose, eyelids, ears, lips, face, scalp, extremities and nails/digits
By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Objective 2: Identify the histologic features and hallmarks of various cutaneous malignancies, from common to rare.
By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Objective 3: Identify the standard of care treatment for difficult/high-risk cutaneous tumors.
By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Please answer the following:
Do you believe this activity was appropriate for the scope of your professional practice?
Yes
No
NA
Was the educational content scientifically sound?
Yes
No
NA
Was the educational content free from commercial bias?
Yes
No
Was the mode of education effective for learning?
Yes
No
If faculty spoke about off-label or investigational uses of a product, was that information disclosed to you?
Yes
No
NA
If you answered 'No' to any of the above questions, please explain:
Were you solicited by sales personnel in an educational room while you attended this educational activity?
Yes
No
NA
If you answered 'Yes' to the above question, please explain:
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What did you learn during this activity that you intend to integrate into your practice?
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What questions have arisen in your practice for which you need answers/strategies that you can implement?
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What patient problems or patient challenges do you feel you are not able to address appropriately or to your satisfaction?
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What problems are your patients communicating to you that need attention or follow-up?
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Are you interested in basic, intermediate or advanced level trainings?
Basic
Intermediate
Advanced
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What barriers might you have that would interfere with implementation of new information from this training?
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How could
this
training be improved to impact your competence or performance in practice?
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Additional comments regarding the speaker or session:
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New Important Information That Should be Presented to Improve My KNOWLEDGE (basic knowledge about the disease): (Check all that apply)
Melanoma
Basic Science
Immunotherapies
Chemotherapy
SLNB
Excisions/Margins
Merkel Cell
Basic Science
SLNB
Multidisciplinary
Treatment
Basal Cell
Basic Science
New Gene/Immunotherapies
High Risk Tumors
Squamous Cell
Basic Science
New Chemotherapies
Multidisciplinary
Approach to Large/Recurrent Tumors
Other Tumors
DFSP
Sebaceous Carcinoma
Eccrine Carcinoma
Extramammary Paget's Disease
Dermatopathology (Diagnosis, Stains, Artifacts, Mimickers
Surgery
Flaps
Grafts
Technology
New Sutures
New Closure Devices
PDT
XRT
Lab
Surviving Inspection
Immunostaining
Program Directors (past, present and future)
How to write or maintain a PIF
Preparing for a site visit
Surviving a site visit
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New Important Information That Should be Presented to Improve My PRACTICE (assist with direct patient care): (Check all that apply)
Melanoma
Basic Science
Immunotherapies
Chemotherapy
SLNB
Excisions/Margins
Merkel Cell
Basic Science
SLNB
Multidisciplinary
Treatment
Basal Cell
Basic Science
New Gene/Immunotherapies
High Risk Tumors
Squamous Cell
Basic Science
New Chemotherapies
Multidisciplinary
Approach to Large/Recurrent Tumors
Other Tumors
DFSP
Sebaceous Carcinoma
Eccrine Carcinoma
Extramammary Paget's Disease
Dermatopathology (Diagnosis, Stains, Artifacts, Mimickers
Surgery
Flaps
Grafts
Technology
New Sutures
New Closure Devices
PDT
XRT
Lab
Surviving Inspection
Immunostaining
Program Directors (past, present and future)
How to write or maintain a PIF
Preparing for a site visit
Surviving a site visit
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Other new information that should be including in upcoming meetings:
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Did you visit the Exhibit Hall?
Yes
No
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The next ACMS Annual Meeting will take place Thursday, May 2 - Sunday, May 5, 2013 at Omni Shoreham, Washington, D.C. Please check the statement below which closely reflects your attendance at this meeting:
I will definitely attend the meeting
I don't know if I will attend the meeting
I will NOT be attending the meeting
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