CPHP-COPIC Sponsored Activity Evaluation Form

Please complete Evaluation Form post-presentation.
Running on Empty, Combatting Burnout

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* 1. Professional Degree

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* 2. Please Fill in one-COPIC Insured?

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* 3. Overall, how would you rate this educational activity?

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* 4. How likely will this educational activity help improve your practice?     

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* 5. Content was relevant to my educational needs?

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* 6. Educational format was conducive to learning?

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* 7. How knowledgeable in the areas covered was the presenter?

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* 8. Did the presenter communicate clearly and efficiently?

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* 9. How likely will this educational activity help improve your practice?

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* 10. I will seek additional information on this subject?

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* 11. Was there any commercial bias expressed by speakers or in meeting process?

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* 12. Was the meeting room conducive to learning?

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* 13. Indicate the reason you came to the meeting.

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* 14. List a minimum of two things you are going to change in your practice as a result of what you have learned at this activity.

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* 15. Describe the barriers anticipated when implementing the above changes and how you will address those barriers.

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* 16. Based on your educational needs and/or perceived practice gaps in your specialty, please list any topics you would like to see addressed in future educational activities.

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* 17. Addressing gaps in competence. (what you knew on the content before this activity)

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* 18. Addressing gaps in competence. (what you have learned with this activity)

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* 19. Addressing gaps in performance. (how likely are you going to implement what you have learned)

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* 20. Addressing gaps in patient outcomes. (how likely what you are going to implement with effect patients)

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