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

Profession

How many credit hours did you complete?

Credit Hours (maximum: 19.5)

Agreement

By completing this form, you attest that you have attended the number of hours you have indicated above.

I agree

Objective 1: Explain how to administer and lead a pediatric graduate medical education program

By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my program.

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 program outcomes should improve due to the implementation of newly-learned strategies.

Objective 2: Describe how to build resilience against burnout in pediatric faculty and trainees

By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my program.

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 program outcomes should improve due to the implementation of newly-learned strategies.

Please answer the following:

Was the educational content scientifically sound?

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?

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?

If you answered 'Yes' to the above question, please explain in detail (e.g. who, when, where):

What questions have arisen in your program for which you need answers/strategies that you can implement?

How could this training (the overall meeting) be improved to better impact your program?

Additional comments: