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ACMS - 2013 Mohs College Regional Meeting
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Agreement
By completing this form, you attest that you have attended the activity in its entirety.
Please rate the following:
The program was relevant to my work.
Content matched stated objectives.
Usefulness of handouts/AV.
Quality of facilities.
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:
Objective 1: Mohs surgeons will explain the inherent limitations of the bilobed flap for large and distal nasal defects.
By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Objective 2: Describe the importance for including a mitotic index on all melanomas received from the dermatopathologist.
By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Objective 3: Identify the inherent limitations of shave biopsy for SCC.
By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Objective 4: Describe the correlation between prognosis and diameter of nerve infiltrated by SCC.
By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Objective 5: Identify the advantages and indications for prognostic tests including SLN biopsy.
By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Objective 6: Mohs surgeons will review the AJCC staging for SCC.
By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Please answer the following:
Do you believe this activity was appropriate for the scope of your professional practice?
Was the educational content scientifically sound?
Was the educational content free from commercial bias?
Was the mode of education effective for learning?
If faculty spoke about off-label or investigational uses of a product, was that information disclosed to you?
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?
If you answered 'Yes' to the above question, please explain:
What did you learn during this activity that you intend to integrate into your practice?
What questions have arisen in your practice for which you need answers/strategies that you can implement?
What patient problems or patient challenges do you feel you are not able to address appropriately or to your satisfaction?
What problems are your patients communicating to you that need attention or follow-up?
Are you interested in basic, intermediate or advanced level trainings?
What barriers might you have that would interfere with implementation of new information from this training?
How could this training be improved to impact your competence or performance in practice?
Additional comments regarding the speaker or session:
New Important Information That Should be Presented to Improve My KNOWLEDGE(basic knowledge about the disease/topic): (Check all that apply)
Melanoma
Merkel Cell
Basal Cell
Squamous Cell
Other Tumors
Surgery
Technology
Lab
Healthcare Reform and Government Regulatory Issues
Information Technology and Practice Administration
Program Directors (past, present and future)
New Important Information That Should be Presented to Improve My PRACTICE (assist with direct patient care): (Check all that apply)
Melanoma
Merkel Cell
Basal Cell
Squamous Cell
Other Tumors
Surgery
Technology
Lab
Healthcare Reform and Government Regulatory Issues
Information Technology and Practice Administration
Program Directors (past, present and future)
Other new information that should be including in upcoming meetings:
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