Participant Evaluation Form Survey

	Excellent	Good	Fair	Poor
Knowledge of subject	Knowledge of subject Excellent	Knowledge of subject Good	Knowledge of subject Fair	Knowledge of subject Poor
Organization and clarity of content	Organization and clarity of content Excellent	Organization and clarity of content Good	Organization and clarity of content Fair	Organization and clarity of content Poor
Effectiveness of teaching methods	Effectiveness of teaching methods Excellent	Effectiveness of teaching methods Good	Effectiveness of teaching methods Fair	Effectiveness of teaching methods Poor

Excellent

Good

Fair

Poor

Knowledge of subject

Knowledge of subject Excellent

Knowledge of subject Good

Knowledge of subject Fair

Knowledge of subject Poor

Organization and clarity of content

Organization and clarity of content Excellent

Organization and clarity of content Good

Organization and clarity of content Fair

Organization and clarity of content Poor

Effectiveness of teaching methods

Effectiveness of teaching methods Excellent

Effectiveness of teaching methods Good

Effectiveness of teaching methods Fair

Effectiveness of teaching methods Poor

	Excellent	Good	Fair	Poor
Knowledge of subject	Knowledge of subject Excellent	Knowledge of subject Good	Knowledge of subject Fair	Knowledge of subject Poor
Organization and clarity of content	Organization and clarity of content Excellent	Organization and clarity of content Good	Organization and clarity of content Fair	Organization and clarity of content Poor
Effectiveness of teaching methods	Effectiveness of teaching methods Excellent	Effectiveness of teaching methods Good	Effectiveness of teaching methods Fair	Effectiveness of teaching methods Poor

Excellent

Good

Fair

Poor

Knowledge of subject

Knowledge of subject Excellent

Knowledge of subject Good

Knowledge of subject Fair

Knowledge of subject Poor

Organization and clarity of content

Organization and clarity of content Excellent

Organization and clarity of content Good

Organization and clarity of content Fair

Organization and clarity of content Poor

Effectiveness of teaching methods

Effectiveness of teaching methods Excellent

Effectiveness of teaching methods Good

Effectiveness of teaching methods Fair

Effectiveness of teaching methods Poor

	Excellent	Good	Fair	Poor
Knowledge of subject	Knowledge of subject Excellent	Knowledge of subject Good	Knowledge of subject Fair	Knowledge of subject Poor
Organization and clarity of content	Organization and clarity of content Excellent	Organization and clarity of content Good	Organization and clarity of content Fair	Organization and clarity of content Poor
Effectiveness of teaching methods	Effectiveness of teaching methods Excellent	Effectiveness of teaching methods Good	Effectiveness of teaching methods Fair	Effectiveness of teaching methods Poor

Excellent

Good

Fair

Poor

Knowledge of subject

Knowledge of subject Excellent

Knowledge of subject Good

Knowledge of subject Fair

Knowledge of subject Poor

Organization and clarity of content

Organization and clarity of content Excellent

Organization and clarity of content Good

Organization and clarity of content Fair

Organization and clarity of content Poor

Effectiveness of teaching methods

Effectiveness of teaching methods Excellent

Effectiveness of teaching methods Good

Effectiveness of teaching methods Fair

Effectiveness of teaching methods Poor

	Excellent	Good	Fair	Poor
Knowledge of subject	Knowledge of subject Excellent	Knowledge of subject Good	Knowledge of subject Fair	Knowledge of subject Poor
Organization and clarity of content	Organization and clarity of content Excellent	Organization and clarity of content Good	Organization and clarity of content Fair	Organization and clarity of content Poor
Effectiveness of teaching methods	Effectiveness of teaching methods Excellent	Effectiveness of teaching methods Good	Effectiveness of teaching methods Fair	Effectiveness of teaching methods Poor

Excellent

Good

Fair

Poor

Knowledge of subject

Knowledge of subject Excellent

Knowledge of subject Good

Knowledge of subject Fair

Knowledge of subject Poor

Organization and clarity of content

Organization and clarity of content Excellent

Organization and clarity of content Good

Organization and clarity of content Fair

Organization and clarity of content Poor

Effectiveness of teaching methods

Effectiveness of teaching methods Excellent

Effectiveness of teaching methods Good

Effectiveness of teaching methods Fair

Effectiveness of teaching methods Poor

	Excellent	Good	Fair	Poor
Knowledge of subject	Knowledge of subject Excellent	Knowledge of subject Good	Knowledge of subject Fair	Knowledge of subject Poor
Organization and clarity of content	Organization and clarity of content Excellent	Organization and clarity of content Good	Organization and clarity of content Fair	Organization and clarity of content Poor
Effectiveness of teaching methods	Effectiveness of teaching methods Excellent	Effectiveness of teaching methods Good	Effectiveness of teaching methods Fair	Effectiveness of teaching methods Poor

Excellent

Good

Fair

Poor

Knowledge of subject

Knowledge of subject Excellent

Knowledge of subject Good

Knowledge of subject Fair

Knowledge of subject Poor

Organization and clarity of content

Organization and clarity of content Excellent

Organization and clarity of content Good

Organization and clarity of content Fair

Organization and clarity of content Poor

Effectiveness of teaching methods

Effectiveness of teaching methods Excellent

Effectiveness of teaching methods Good

Effectiveness of teaching methods Fair

Effectiveness of teaching methods Poor

	Excellent	Good	Fair	Poor
Knowledge of subject	Knowledge of subject Excellent	Knowledge of subject Good	Knowledge of subject Fair	Knowledge of subject Poor
Organization and clarity of content	Organization and clarity of content Excellent	Organization and clarity of content Good	Organization and clarity of content Fair	Organization and clarity of content Poor
Effectiveness of teaching methods	Effectiveness of teaching methods Excellent	Effectiveness of teaching methods Good	Effectiveness of teaching methods Fair	Effectiveness of teaching methods Poor

Excellent

Good

Fair

Poor

Knowledge of subject

Knowledge of subject Excellent

Knowledge of subject Good

Knowledge of subject Fair

Knowledge of subject Poor

Organization and clarity of content

Organization and clarity of content Excellent

Organization and clarity of content Good

Organization and clarity of content Fair

Organization and clarity of content Poor

Effectiveness of teaching methods

Effectiveness of teaching methods Excellent

Effectiveness of teaching methods Good

Effectiveness of teaching methods Fair

Effectiveness of teaching methods Poor

	Excellent	Good	Fair	Poor
Knowledge of subject	Knowledge of subject Excellent	Knowledge of subject Good	Knowledge of subject Fair	Knowledge of subject Poor
Organization and clarity of content	Organization and clarity of content Excellent	Organization and clarity of content Good	Organization and clarity of content Fair	Organization and clarity of content Poor
Effectiveness of teaching methods	Effectiveness of teaching methods Excellent	Effectiveness of teaching methods Good	Effectiveness of teaching methods Fair	Effectiveness of teaching methods Poor

Excellent

Good

Fair

Poor

Knowledge of subject

Knowledge of subject Excellent

Knowledge of subject Good

Knowledge of subject Fair

Knowledge of subject Poor

Organization and clarity of content

Organization and clarity of content Excellent

Organization and clarity of content Good

Organization and clarity of content Fair

Organization and clarity of content Poor

Effectiveness of teaching methods

Effectiveness of teaching methods Excellent

Effectiveness of teaching methods Good

Effectiveness of teaching methods Fair

Effectiveness of teaching methods Poor

	Excellent	Good	Fair	Poor
Knowledge of subject	Knowledge of subject Excellent	Knowledge of subject Good	Knowledge of subject Fair	Knowledge of subject Poor
Organization and clarity of content	Organization and clarity of content Excellent	Organization and clarity of content Good	Organization and clarity of content Fair	Organization and clarity of content Poor
Effectiveness of teaching methods	Effectiveness of teaching methods Excellent	Effectiveness of teaching methods Good	Effectiveness of teaching methods Fair	Effectiveness of teaching methods Poor

Excellent

Good

Fair

Poor

Knowledge of subject

Knowledge of subject Excellent

Knowledge of subject Good

Knowledge of subject Fair

Knowledge of subject Poor

Organization and clarity of content

Organization and clarity of content Excellent

Organization and clarity of content Good

Organization and clarity of content Fair

Organization and clarity of content Poor

Effectiveness of teaching methods

Effectiveness of teaching methods Excellent

Effectiveness of teaching methods Good

Effectiveness of teaching methods Fair

Effectiveness of teaching methods Poor

	Excellent	Good	Fair	Poor
Knowledge of subject	Knowledge of subject Excellent	Knowledge of subject Good	Knowledge of subject Fair	Knowledge of subject Poor
Organization and clarity of content	Organization and clarity of content Excellent	Organization and clarity of content Good	Organization and clarity of content Fair	Organization and clarity of content Poor
Effectiveness of teaching methods	Effectiveness of teaching methods Excellent	Effectiveness of teaching methods Good	Effectiveness of teaching methods Fair	Effectiveness of teaching methods Poor

Excellent

Good

Fair

Poor

Knowledge of subject

Knowledge of subject Excellent

Knowledge of subject Good

Knowledge of subject Fair

Knowledge of subject Poor

Organization and clarity of content

Organization and clarity of content Excellent

Organization and clarity of content Good

Organization and clarity of content Fair

Organization and clarity of content Poor

Effectiveness of teaching methods

Effectiveness of teaching methods Excellent

Effectiveness of teaching methods Good

Effectiveness of teaching methods Fair

Effectiveness of teaching methods Poor

	Excellent	Good	Fair	Poor
Knowledge of subject	Knowledge of subject Excellent	Knowledge of subject Good	Knowledge of subject Fair	Knowledge of subject Poor
Organization and clarity of content	Organization and clarity of content Excellent	Organization and clarity of content Good	Organization and clarity of content Fair	Organization and clarity of content Poor
Effectiveness of teaching methods	Effectiveness of teaching methods Excellent	Effectiveness of teaching methods Good	Effectiveness of teaching methods Fair	Effectiveness of teaching methods Poor

Excellent

Good

Fair

Poor

Knowledge of subject

Knowledge of subject Excellent

Knowledge of subject Good

Knowledge of subject Fair

Knowledge of subject Poor

Organization and clarity of content

Organization and clarity of content Excellent

Organization and clarity of content Good

Organization and clarity of content Fair

Organization and clarity of content Poor

Effectiveness of teaching methods

Effectiveness of teaching methods Excellent

Effectiveness of teaching methods Good

Effectiveness of teaching methods Fair

Effectiveness of teaching methods Poor

Question Title

* 11. As a result of this activity, I am able to identify 1-2 strategies or resources per presentation they have learned that will contribute to improved quality of patient care, improved processes contributing to optimal patient flow and patient experience.

Yes

No, please explain

Question Title

* 12. Were the presentations free from commercial bias?

Yes

No, please explain

Question Title

* 13. As a result of this activity, please share at least one action you will take to change your professional practice/ performance:

Question Title

* 14. ADMINISTRATIVE ARRANGEMENTS:

	Satisfactory	Unsatisfactory
Promotional information provided adequate information	Promotional information provided adequate information Satisfactory	Promotional information provided adequate information Unsatisfactory
Registration process was efficient	Registration process was efficient Satisfactory	Registration process was efficient Unsatisfactory
Scheduling of the activity met my needs	Scheduling of the activity met my needs Satisfactory	Scheduling of the activity met my needs Unsatisfactory

Participant Evaluation Form

Question Title

* 1. Kamal Jethwani, MD, MPH

Question Title

* 2. Bob Matthews

Question Title

* 3. Bert Thurlo Walsh, MM, RN, CPHQ, FABC

Question Title

* 4. Jill MacCormack, LICSW

Question Title

* 5. Christopher Wellins, MD, MS, FACP

Question Title

* 6. Courtney Pladsen, DNP, FNP, RN

Question Title

* 7. Itay Baruchi, PhD

Question Title

* 8. Michael Mercurio, MBA

Question Title

* 9. Ron McKinnon

Question Title

* 10. Jerry Adach

Question Title

* 11. As a result of this activity, I am able to identify 1-2 strategies or resources per presentation they have learned that will contribute to improved quality of patient care, improved processes contributing to optimal patient flow and patient experience.

Question Title

* 12. Were the presentations free from commercial bias?

Question Title

* 13. As a result of this activity, please share at least one action you will take to change your professional practice/ performance:

Question Title

* 14. ADMINISTRATIVE ARRANGEMENTS:

Question Title

* 15. General comments about the program:

Question Title

* 16. Suggestions for future program topics:

Question Title

* 17. If obtaining CNEs, please leave the email address you would like your certificate sent to

Question Title

* 18. Please enter your name and credentials