1 Start 2 Speaker Evaluation 3 Complete Thank you for attending the Evaluation. Please complete the evaluation below. Please identify your profession * - Select -PhysicianNurseAdvanced Practice ProviderPharmacistEMSOther: Please identify your profession Other: Do you feel the activity was scientifially sound and free of commercial bias or influence? * *Commercial bias is defined as a personal judgment in favor of a specific product or service of a commercial interest. - Select -YesNoIf no, please explain: Do you feel the activity was scientifially sound and free of commercial bias or influence? If no, please explain: Core competencies * Please indicate which of the following American Board of Medical Specialties/Institute of Medicine core competencies were addressed by this educational activity (select all that apply): Patient care or patient-centered care Interpersonal and communication skills Practice-based learning & improvement Professionalism System-based practice Interdisciplinary teams Quality improvement Utilize informatics Medical knowledge Employ evidence-based practice None of the above The content of this activity matched my current (or potential) scope of practice * Yes No If no, please explain: The content of this activity matched my current (or potential) scope of practice If no, please explain: Was there an opportunity to discuss practice-relevant issues with the speakers? * Yes No If no, please explain: Was there an opportunity to discuss practice-relevant issues with the speakers? If no, please explain: How will you change your practice as a result of attending this activity? * (select all that apply) Create/revise protocols, policies, and/or procedures Change the management and/or treatment of my patients This activity validated my current practice I will not make any changes to my practice Other, please specify: How will you change your practice as a result of attending this activity? Other, please specify: Please indicate any barriers you perceive in implementing these changes * (select all that apply) Cost Lack of experience Lack of opportunity Lack of resources Lack of administrative support Lack of time to assess/counsel patients Reimbursement/insurance issues Patient compliance issues Lack of consensus or professional guidelines No barriers Other, please specify: Please indicate any barriers you perceive in implementing these changes Other, please specify: Addressing Barriers How will you address these barriers in order to implement changes in your knowledge, competency, performance, and/or patients’ outcomes? How might the format of this activity be improved in order to be most appropriate for the content presented? Format was appropriate; no changes needed Include more case-based presentations Increase interactivity with attendees Add breakouts for sub topics Add a hands-on instructional component Schedule more time for Q&A Other, describe: How might the format of this activity be improved in order to be most appropriate for the content presented? Other, describe: Format's conduciveness to learning - None -ExcellentGoodFairPoor Additional Logistical Comments Length Of Activity - None -Too ShortAdequateToo Long What could improve this activity? Based on your educational needs, please list any topics you would like to see addressed in future educational activities Other Comments: Learning Objective #1 * Review the hearing targeted cCMV screening process. 0123 Knowledge Knowledge - 0 Knowledge - 1 Knowledge - 2 Knowledge - 3 Competence Competence - 0 Competence - 1 Competence - 2 Competence - 3 Performance Performance - 0 Performance - 1 Performance - 2 Performance - 3 Patient Outcome Patient Outcome - 0 Patient Outcome - 1 Patient Outcome - 2 Patient Outcome - 3 Learning Objective #2 * Discuss the process for relaying cCMV results to Primary Care Providers. 0123 Knowledge Knowledge - 0 Knowledge - 1 Knowledge - 2 Knowledge - 3 Competence Competence - 0 Competence - 1 Competence - 2 Competence - 3 Performance Performance - 0 Performance - 1 Performance - 2 Performance - 3 Patient Outcome Patient Outcome - 0 Patient Outcome - 1 Patient Outcome - 2 Patient Outcome - 3 Learning Objective #3 * Identify cCMV testing and treatment options and describe an overview of the care process model. 0123 Knowledge Knowledge - 0 Knowledge - 1 Knowledge - 2 Knowledge - 3 Competence Competence - 0 Competence - 1 Competence - 2 Competence - 3 Performance Performance - 0 Performance - 1 Performance - 2 Performance - 3 Patient Outcome Patient Outcome - 0 Patient Outcome - 1 Patient Outcome - 2 Patient Outcome - 3 Leave this field blank
