Sample Course
How would you like your name to appear on your certificate?
Profession
Select Your Profession
Other
Physician
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Agreement
By completing this form, you attest that you have attended the activity in its entirety.
I agree
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Please rate the following:
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
Comments:
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Objective 1: Define cultural awareness, sensitivity and competency
The above objective was met and my professional competence will increase because I have acquired new strategies to use in my practice.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Objective 2: Describe how the end-of-life process is impacted by the basic values and cultural/spiritual perspectives for each of the subcultures discussed.
The above ojbective was met and my professional competence will increase because I have acquired new strategies to use in my practice.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Instructor's knowledge of subject matter, clarity of delivery and responsiveness.
Highly Effective
Effective
Neutral
Ineffective
Highly Ineffective
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Instructional materials were suitable and useful.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Overall technology and administration of the program.
Highly Effective
Effective
Neutral
Ineffective
Highly Ineffective
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Technology was accessible, user-friendly, responsive and appropriate to support learning.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Instructions for requesting disability accommodations were clear during registration.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Please answer the following:
Was the educational content scientifically sound, effective, appropriate and relevant to my practice?
Yes
No
NA
If you answered 'No' to the above question, please explain:
Did you perceive any product/service/company/commercial bias in any educational session you attended or materials you received?
Yes
No
If you answered "Yes" to the above question, please detail the situation below (e.g. session title, speaker name):
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What questions have arisen in your practice for which you need answers/strategies that you can implement?
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How could
this
training (the overall meeting) be improved to better impact competence, performance and/or patient/client outcomes?
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How long did it take you to complete this home study course?
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Additional comments:
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