!!! Baseline Eval Template
How would you like your name to appear on your certificate?
Profession
Select Your Profession
Non-Physician
Physician
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How many credit hours did you complete?
Credit Hours (maximum: 1.5)
Agreement
By completing this form, you attest that you have attended the number of hours you have indicated above.
I agree
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Was the educational content of value to you?
Very Valuable
Average
Waste of time
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Was the educational content scientifically sound?
Yes
No
If no, tell us how...
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Did you perceive any commercial bias or influence in the educational content?
Yes
No
If yes, please explain...
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Did this activity improve your Skills or Strategy?
Yes
No
If yes, how...
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Did the activity give a balanced view of therapeutic options?
Yes
No
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Were all the recommendations involving clinical medicine in the activity based on evidence that is accepted within the health profession being addressed as adequate justification for their indications and contraindications in the care of patients?
Yes
No
Did all scientific research referred to, reported or used in support or justification of a patient care recommendation conform to the generally accepted standards of experimental design, data collection and analysis?
Yes
No
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To what extent did you increase your skills/knowledge to enhance your effective collaboration by interacting with and learning from fellow learners in this activity?
Significant
Somewhat Significant
Neutral
Somewhat Insignificant
Insignificant
N/A
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Tell us how well or poorly we met any of the educational objectives
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Do you think what you learned will benefit you in your practice?
If yes, how...
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Tell us what was good or bad about any part of the educational activity, content, speakers, materials, anything
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What questions are you having in your practice that you would like to see addressed in an educational activity?
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