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* 1. I am a:

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* 2. Did you perceive any degree of bias in any part of the program:

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* 3. Did the activity respect the CQDPCM Codes of Ethics?
(http://cqdpcm.ca/)

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* 4. Please indicate which CanMeds-FMS roles you feel were addressed during this educational activity - select all that apply

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* 5.  The Program

  Strongly disagree Disagree Neutral Agree Strongly agree
Was consistent with stated objectives:
Information was presented clearly:
Information was relevant to my practice:
Discussion time was adequate:

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* 6. I heard about the webinar through:

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* 7. The webinar:

  Strongly Disagree Disagree Neutral Agree Strongly Agree
The webinar was relevant to my rural practice:
The webinar fulfilled its announced educational objectives:
Overall I was satisfied with the webinar:
The webinar was presented in a well-organized manner:
The webinar was credible and non-biased:
There was adequate opportunity for audience participation:
Participants were treated respectfully:

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* 8. What did you like about this webinar?

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* 9. What could we have done to improve this webinar?

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* 10. Considering your practice, what future educational sessions would help you provide culturally appropriate care?  Please rank these topics for potential future sessions.

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* 11. After this webinar, what is one thing you will change in your practice?

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* 12. What are other areas of interest that you would like to see addressed at future SRPC webinars?

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* 13. Comments and suggestions:

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