PracticeClient1 - Real Leadership
How would you like your name to appear on your certificate?
Profession
Select Your Profession
Addictions & Substance Abuse Counselor
Marriage and Family Therapist
Other
Psychologist
Physician
Nurse
Psychologist
Counselor
Marriage & Family Therapist
Addictions Professional
Social Worker
Other
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How many credit hours did you complete?
Credit Hours (maximum: 2.5)
Agreement
By completing this form, you attest that you have attended the number of hours you have indicated above.
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
Usefulness of handouts/AV/technology.
Excellent
Very Good
Good
Fair
Poor
Quality of facilities/facility accomodations or website/accessibility, if online.
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 in detail (e.g. session title, speaker name, situation):
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Learning Objectives:
The stated Learning Objectives for the activity were met.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
If you disagreed with the above statement, please explain:
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Faculty Evaluation:
Please rate the speaker(s) of this session as a group. You will have the opportunity to elaborate on an individual speaker in the following question.
Excellent
Very Good
Good
Fair
Poor
If you have additional comments regarding the session or individual speaker(s) - e.g. content issues, teaching ability, credentials or expertise, etc. - please use the space below:
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Were the following objectives met?
asdf
Yes
No
I don't know
Were the following objectives met?
;lkj
Yes
No
I don't know
Were the following objectives met?
qwer
Yes
No
I don't know
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Did this program improve your Skill or Strategy in your role or contribution as a member of the healthcare team?
Yes
No
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Please explain how, or why not?
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Please answer the following:
Was the educational content scientifically sound?
Yes
No
N/A
If faculty spoke about off-label or investigational uses of a product, was that information disclosed to you?
Yes
No
N/A
Was the mode of education effective to learning?
Yes
No
If you resonded "No" to any of the preceding questions, please explain why:
Did you perceive any commercial bias or influence in the educational content?
Yes
No
If you answered "Yes" to the above question, please detail the situation below (e.g. session title, speaker name):
Were you solicited by sales personnel in an
educational
area (other areas do not matter) while you attended this educational activity?
Yes
No
If you answered "Yes" to the above question, please explain in detail (e.g. who, when, where):
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Do you believe your participation in this activity will positively impact your healthcare team?
Yes
No
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Why, or why not?
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What questions are you having in your practice that you would like to see addressed in an educational activity?
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What barriers might you have that would interfere with implementation of new information learned from this training?
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How can this training (the overall meeting) be improved to better impact knowledge, strategies/skills, performance and/or patient outcomes?
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Additional comments:
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