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

Profession

What activities did you attend at the event?

Current Topics in Pain Management

Agreement

By completing this form, you attest that you have participated in all selected activities in thier entirety.

I agree

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:

Please rate the speaker(s) 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. teaching ability, expertise, organization of materials, etc. - please use the space below:

Please rate how well you are able to meet the following objectives:

Identify initial treatment options for managing pain

List common adverse effects associated with the use of opioids

Describe treatment strategies for opioid related adverse effects

Identify initial treatment options for managing pain

List common adverse effects associated with the use of opioids

Describe treatment strategies for opioid related adverse effects

Calculate equianalgesic doses of different opioids

List two advantages and disadvantages of using methadone for chronic pain management

Make recommendations regarding acute pain management for patients already on buprenorphine or buprenorphine/nalaxone

Identify the relative potencies of opioids

Identify potential uses of methadone

Discuss the need for increased monitoring when patients on buprenorphine or buprenorphine/naloxone are being treated for acute pain

Please answer the following:

Do you believe this activity was appropriate for the scope of your professional activities?

Was the educational content scientifically sound?

Was the educational content free of commercial bias?

Was the mode of education effective to 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?

My professional competence would be improved if I had training on:

My professional performance would be improved if I had training on:

My patient outcomes would be improved if I had training on:

Are you interested in basic, intermediate or advanced level trainings?

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

How can this training be improved to better impact competence, performance and/or patient outcomes?

Additional comments: