ࡱ> PRO &bjbj 4$rr (8Hd,M.${- F`j0M, /  M  : TEMPLATE RSS ACTIVITY NAME (Grand Rounds, Case Presentation, Journal Club) EVALUATION Your comments are essential for improving the effectiveness of KSOM continuing medical education activities. Thank you for completing this evaluation. Topic: ______________________________ Date: ________ RSS#: _________ Presenter(s): (list names and titles) Objectives: Following participation in this activity, participants should be able to: List specific lecture objectives for specific presenter (grand rounds) Or List global learning objectives for case conferences and journal clubs Please indicate to what degree you support the following statements by circling one of the following: (1-Strongly disagree; 2-Disagree; 3-Undecided; 4-Agree; 5-Strongly agree) Disagree Agree This activity met the stated objectives 1 2 3 4 5 The activitys format was appropriate for the topic 1 2 3 4 5 The activity was relevant to my practice 1 2 3 4 5 The activity was free from commercial bias 1 2 3 4 5 Please rate the overall impact of this educational activity on your professional: Poor Fair Good Very Good Excellent knowledge 1 2 3 4 5 competence 1 2 3 4 5 c. performance 1 2 3 4 5 d. patient care outcomes 1 2 3 4 5 Please estimate the likelihood that you will make changes in your practice setting as a result of this CME activity: Not at All Unlikely Somewhat Likely Highly Likely Definitely 1 2 3 4 5 Please list changes in your practice you intend to make as a result of participating in this CME activity. 1. ________________________________________________________________________________________ 2. ________________________________________________________________________________________ Which of the following competency areas do you feel have been improved as a result of this activity? (Mark all that apply). ___ Patient care or patient-centered care ___ System-based practice ___ Interpersonal and communication skills ___ Interdisciplinary teams ___ Practice-based learning & improvement ___ Quality improvement ___ Professionalism ___ Utilize informatics ___ Employ evidence-based practice Suggestions for future topics: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ I am a : ___ USC Faculty ___ Fellow ___ Resident ___ Other     FY 2014-15 Rev: 06/2012   JKLVXY   8 : F G H R S ] ^ _ l m H       = @ A K L M a e ѶѶѶѶњѐыњѶњ h55h)%hZv%5>* hvk5h)%h)%6h)%h_ h)%h)% h)%5 h?Z5 h]5 hPvRh] hPvR5 hZv%5hZv%hs5hZv%hZv%5 h/5 h_5 h5 h[15 h256 LWXY9 : ` a  H I J K  K L gd)% gdEgdZv%gd]$a$gdZv%e   N s t } ~ Q R  Ͻḳ hZ5h;hZ5h;hH5h]hkF hEhY5 hEh> hkF5 h>5 hEhaP hEhEh haPhE h;5 hE5 h]5 h'5 h)%5 h55 hvk5 hZv%55 N O s  VP%h`hgdaP hVP%h`hgdaP & F VP%h^h`gdaP & F VP%h^h`gd  <$gdEgdZv% R  ghDEIlmn`gdOgdO 2 (#gdY5  !gd>gdZv%  EHIl  !"#$%&ĹhxhB7hSCJaJh%nCJaJh?CJaJh%nh%nCJaJhO1ajhO1aU h5h5 hZ%5hOhM hhO hO5 htlS5 hIrj5 hdW5IJ "#$%&gdB721h:pZv%/ =!@"@#$% ^ 02 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ Zv%NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR 0 Table Normal4 l4a (k ( 0No List H@H )% Balloon TextCJOJQJ^JaJ44 B7Header  H$6o6 B7 Header CharCJaJ4 @"4 B70Footer  H$6o16 B70 Footer CharCJaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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I2 &)0 Thank you for completing this evaluation.      2 .0   ---  2 &0    2 &0 Topic:  2 V0 _______ 2 0 _____ &2 0 __________________  2 F0  0  2 v0  0 2 0 Date:   2 0   2 0 ________  2 0  '  2 60  0 "2 f0 RSS#: _________   2 0     2 &0   --- 2 & 0 Presenter(s)   2 x0 :  2 }0  --- 2  0 (list name   2 0 s  2 0   2  0 and title  2 0 s  2 0 )---  2 0     2 &0    0'--- 2 -& 0 Objectives:   2 -r0  --- y2 -wI0 Following participation in this activity, participants should be able to:         2 -40   @Times New Roman------ t2 @&F0 List specific lecture objectives for specific presenter (grand rounds)   2 @0    2 R&0 Or   2 R70    t2 d&F0 List global learning objectives for case conferences and journal clubs   2 d0   ---  2 w&0     2 &0     2 &0    2 &e0 Please indicate to what degree you support the following statements by circling one of the following:       2 0    2 &0 (1  2 30 - )2 80 Strongly disagree; 2   2 0 - 2  0 Disagree; 3   2 0 - 2  0 Undecided; 4   2 s0 - 2 x0 Agree; 5   2 0 - "2 0 Strongly agree)   2 "0     2 &0     2 &0  0  2 V0  0  2 0  0  2 0  0  2 0  0  2 0  0  2 F0  0  2 v0  0  2 0  0 2 0 Disagree   2 0  #  2 60  0  2 f0  0 2 0 Agree   2 0  @Times New Roman------- @ !=-- @ !)- ---  2 &0 T  2 00 his act :2 \0 ivity met the stated objectives   2 &0    2 F0  0  2 v0  0  2 0  0  2 0 1  2 0  (  2 0 2  2 0  (  2 60 3  2 >0  (  2 f0 4  2 n0  (  2 0 5  2 0     2 &0     2 &0 T  )2 00 he activitys format   2 0   2 0 was   2 0   12 0 appropriate for the topic   2 0  '  2 0  0  2 0 1  2 0  (  2 0 2  2 0  (  2 60 3  2 >0  (  2 f0 4  2 n0  (  2 0 5  2 0     2 /&0     2 A&0 T   2 A00 h  2 A80 e  2 A@0   2 AE0 activity  2 Av0   2 A{0 was   2 A0   2 A 0 relevant to  2 A0 my   2 A0   2 A0 practice  2 A50    2 AF0  0  2 Av0  0  2 A0  0  2 A0 1  2 A0  (  2 A0 2  2 A0  (  2 A60 3  2 A>0  (  2 Af0 4  2 An0  (  2 A0 5  2 A0     2 T&0     2 f&0 T   2 f00 h  2 f80 e  2 f@0   2 fE0 activity  2 fv0   2 f{0 was   2 f0   12 f0 free from commercial bias    2 fM0  )  2 fv0  0  2 f0  0  2 f0 1  2 f0  (  2 f0 2  2 f0  (  2 f60 3  2 f>0  (  2 ff0 4  2 fn0  (  2 f0 5  2 f0     2 x&0     2 &0    2 &0 Plea  52 C0 se rate the overall impact o   2 0 f  2 0   R2 /0 this educational activity on your professional:  2 ;0   ---  2 &0     2 &0   2 0 Poor   2 40  6 2 j0 Fair   2 0  H 2 0 Good   2 0  = 2 * 0 Very Good    2 q0  % 2  0 Excellent   2 0    0'@"Arial--------- 2 >0 a.---  2 I0  ---  2 V0 k 2 ^0 nowledge   2 0  ~  2 0    2 "0 1  2 *0  F  2 p0 2  2 x0  ^  2 0 3  2 0  j  2 H0 4  2 P0  ^  2 0 5  2 0    0'--- 2 >0 b.---  2 J0  --- 2 V 0 competence   2 0  w  2 0    2 "0 1  2 *0  F  2 p0 2  2 x0  ^  2 0 3  2 0  j  2 H0 4  2 P0  ^  2 0 5  2 0    0' 2 >0 c.  2 I0   2 V 0 performance   2 0    2 "0 1  2 *0  F  2 p0 2  2 x0  ^  2 0 3  2 0  j  2 H0 4  2 P0  ^  2 0 5  2 0    0' 2 >0 d.  2 J0   +2 V0 patient care outcomes   2 0  D  2 "0 1  2 *0  F  2 p0 2  2 x0  ^  2 0 3  2 0  j  2 H0 4  2 P0  ^  2 0 5  2 0    0'---  2 &0     2 0&0     2 C&0    @2 U&#0 Please estimate the likelihood that     2 U 0   v2 UG0 you will make changes in your practice setting as a result of this CME        2 h& 0 activity:  2 h\0     2 z&0  0 2 zV 0 Not at All    2 z0  % 2 z0 Unlikely    2 z0  . 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