Department of Health Humanities & Bioethics CME Form Question Title * 1. Title of Activity: Question Title * 2. Date of Presentation Question Title * 3. Name & Contact Information: Name Email Address Phone Number Question Title * 4. Birth Date: (MM/DD Format) Question Title * 5. In order to improve the quality of these sessions, we would appreciate your completing this short evaluation. All responses are strictly confidential.Professional category MD PhD RN NP Student SW Question Title * 6. How satisfied were you with today's presentation? 1 - Very Dissatisfied 5 - Very Satisfied Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 7. Name one way your knowledge about the profession and the practice of medicine has changed as a result of today's session: Question Title * 8. Name one way your knowledge has changed as a result of today's session and how you will apply this knowledge to your clinical practice in one of the following competencies: professionalism, interpersonal skills, patient care, self-awareness, cultural sensitivity/diversity or other area. Question Title * 9. Please rate the relevance of the material to your particular interest and needs: Very relevant Relevant Not relevant Question Title * 10. List suggestions or comments you have regarding future topics you would like addressed, or ideas on how these sessions could be improved (optional): Question Title * 11. You feel this activity was free of commercial bias or influence? If no, please explain*Commercial bias is defined as a personal judgement in favor of a specific product or service of a commercial interest. Question Title * 12. Do you feel this activity was evidence-based? If not, please explain. Done