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

What facility are you from?

The program was relevant to my work.

Usefulness of handouts/AV/technology.

Quality of facilities/facility accomodations or website/accessibility, if online.

How well did the educational sessions give a balanced view of therapeutic options, including the use of generic names?

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):

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. 

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:

1. Recognize that using a framework to discuss goals of care with seriously ill patients or their surrogates improves the quality of the conversation and is efficient.

2. List at least five strategies for responding to emotion during a serious illness conversation.

3. Understand how to determine decisional capacity and recognize that patients without decisional capacity to make complicated medical decisions may still be able to contribute to serious illness conversations.

If you disagreed, please tell us why:

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

Please explain how, or why not?

Was the educational content scientifically sound?

If faculty spoke about off-label or investigational uses of a product, was that information disclosed to you?

Was the mode of education effective to learning?

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?

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?

If you answered "Yes" to the above question, please explain in detail (e.g. who, when, where):

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

Why, or why not?

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

What barriers might you have that would interfere with implementation of new information learned from this training?

How can this training (the overall meeting) be improved to better impact knowledge, strategies/skills, performance and/or patient outcomes?

Additional comments: