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

Profession

Agreement

By completing this form, you attest that you have attended the activity in its entirety.

I agree

Since attending the IHC workshop, I have used "Technique 1" listed in attached form...

Always

Often

Sometimes

Not at all

Since attending the IHC workshop, I have used "Technique 2" listed in attached form...

Always

Often

Sometimes

Not at all

Please check the following impacts that you believe resulted from your participation in the workshop and from your use of these techniques in practice (check all that apply):

I have increased the percentage of time I've spent listening to my patients

I feel more satisfied with my patient interactions

My patients are more satisfied with our interations

I am making more accurate diagnoses

I am more actively engaging my patients in decision-making

My patients have a better understanding of their health conditions

My patients are more likely to follow through on treatment recommendations

My patients are better able to manage their health conditions

None of the above

If other impacts, not listed above, resulted from participation in the workshop, please describe:

Tell us what we should include in future CE workshops to improve your confidence and competence communicating with patients, and/or staff and colleagues. (Check all that apply)

Research evidence and knowledge, Specify topics e.g., patient safety, diabetes self- management, etc.

Communication tools and skills, Specify, e.g., skills to improve patient adherence, tools to improve patient safety, giving bad news, empathy, etc.

Communication practice opportunities, Specify, e.g., simulated patient interviews, hands-on team communication tools, etc.

Other

For all areas selected above, please specify your suggestions here.

If your profession was not listed above, please list is here: