NASPGHAN - CPNP Symposium 2015
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Profession
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Dietitian
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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:
The program was relevant to my work.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
Content matched stated objectives.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
Usefulness of handouts/AV.
Excellent
Very Good
Good
Fair
Poor
Quality of facilities.
Excellent
Very Good
Good
Fair
Poor
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
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):
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Objective 1: Apply medical nutrition therapy in disease prevention and management
By meeting the above objective 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
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Objective 2: Maintains the knowledge and skill to manage a variety of disease states and clinical conditions
By meeting the above objective 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
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Objective 3: Take action to address deficiencies to enhance practice
By meeting the above objective 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
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Objective 4: Keeps abreast of current nutrition and dietetics knowledge and trends
By meeting the above objective 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
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Please answer the following:
Do you believe this activity was appropriate for the scope of your professional practice or activities?
Yes
No
Was the educational content scientifically sound?
Yes
No
Was the mode of education effective for learning?
Yes
No
If you answered 'No' to any of the above questions, 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):
Were you solicited by sales personnel in an
educational room
(other areas do not matter) while you attended this educational activity?
Yes
No
If you answered 'Yes' to the above question, please explain in detail (e.g. who, when, where):
How much did you learn as a result of this educational program?
Great deal
Quite a bit
Some
Very little
Nothing
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What specifically did you learn during this activity that you intend to integrate into your practice?
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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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What patient/client problems or patient/client challenges do you feel you are not able to address appropriately or to your satisfaction?
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What problems are your patients/clients communicating to you that need attention or follow-up?
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Are you interested in basic, intermediate or advanced level trainings?
Basic
Intermediate
Advanced
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What barriers might you have that would interfere with implementation of new information learned from this training?
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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 did you hear about the conference?
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Are the topics relevant to your practice? Why or why not?
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What topics or speakers would you like to see in the future?
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Do you think this symposium should be held over 1 day or 2 days?
1 Day
2 Days
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Is this format with didactic sessions in the morning and breakout sessions in the afternoon good or would you suggest an alternative format?
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Was there a good balance among speakers with some RD and some non-RD speakers?
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Would you consider joining the Pediatric Dietitian Organization that will be affiliated with NASPGHAN if the fee were nominal?
Yes
No
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Would you consider joining the leadership of such an Organization?
Yes
No
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Would you be interested in helping plan next year’s symposium?
Yes
No
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Are you predominantly a pediatric dietitian?
If no, please explain
If yes, do you have a subspecialty that you work in?
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Additional comments:
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