Spring CME Conference on Adolescent Health Evaluation Survey

Adolescent Health CME Evaluation Survey

Please complete this evaluation survey in order to receive a CME or CE credit certificate. Make sure to answer all of the questions for each presentation you attended. If you did not attend a particular presentation, please skip that question. Thank you!

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* 1. Full Name
(Please make sure to type it as you want it to appear on your certificate)

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* 2. AAP ID#
(If you are not an AAP member, write N/A)

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* 3. Type of practice or license

Physician MD

Physician DO

Nurse

Nurse Practitioner

Physician Assistant

Other

Other (please specify)

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* 4. Email address

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* 5. This virtual format educational program met my expectations for improving my knowledge of the topics presented.

Yes

No

Comments

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* 6. Risk Taking in Adolescence | Bonnie Halpern-Felsher, PhD, FSAHM

	Excellent	Above Average	Average	Below Average	Poor
Topic knowledge	Topic knowledge Excellent	Topic knowledge Above Average	Topic knowledge Average	Topic knowledge Below Average	Topic knowledge Poor
Ability to communicate	Ability to communicate Excellent	Ability to communicate Above Average	Ability to communicate Average	Ability to communicate Below Average	Ability to communicate Poor
Clarity of materials	Clarity of materials Excellent	Clarity of materials Above Average	Clarity of materials Average	Clarity of materials Below Average	Clarity of materials Poor
Relevance to my practice	Relevance to my practice Excellent	Relevance to my practice Above Average	Relevance to my practice Average	Relevance to my practice Below Average	Relevance to my practice Poor

Comments on speaker/presentation: if you sensed personal or commercial bias please list that here also.

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* 7. Adolescent Mental Health | Shashank Joshi, MD, FAAP, DFAACAP

	Excellent	Above Average	Average	Below Average	Poor
Topic knowledge	Topic knowledge Excellent	Topic knowledge Above Average	Topic knowledge Average	Topic knowledge Below Average	Topic knowledge Poor
Ability to communicate	Ability to communicate Excellent	Ability to communicate Above Average	Ability to communicate Average	Ability to communicate Below Average	Ability to communicate Poor
Clarity of materials	Clarity of materials Excellent	Clarity of materials Above Average	Clarity of materials Average	Clarity of materials Below Average	Clarity of materials Poor
Relevance to my practice	Relevance to my practice Excellent	Relevance to my practice Above Average	Relevance to my practice Average	Relevance to my practice Below Average	Relevance to my practice Poor

Comments on speaker/presentation: if you sensed personal or commercial bias please list that here also.

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* 8. Adolescent Media Use and Abuse | Shafia Zaloom

	Excellent	Above Average	Average	Below Average	Poor
Topic knowledge	Topic knowledge Excellent	Topic knowledge Above Average	Topic knowledge Average	Topic knowledge Below Average	Topic knowledge Poor
Ability to communicate	Ability to communicate Excellent	Ability to communicate Above Average	Ability to communicate Average	Ability to communicate Below Average	Ability to communicate Poor
Clarity of materials	Clarity of materials Excellent	Clarity of materials Above Average	Clarity of materials Average	Clarity of materials Below Average	Clarity of materials Poor
Relevance to my practice	Relevance to my practice Excellent	Relevance to my practice Above Average	Relevance to my practice Average	Relevance to my practice Below Average	Relevance to my practice Poor

Comments on speaker/presentation: if you sensed personal or commercial bias please list that here also.

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* 9. Small Group Discussion:
Motivational Interviewing | Seth Ammerman, MD, FAAP

	Excellent	Above average	Average	Below Average	Poor	N/A (Did not attend this session)
Topic knowledge	Topic knowledge Excellent	Topic knowledge Above average	Topic knowledge Average	Topic knowledge Below Average	Topic knowledge Poor	Topic knowledge N/A (Did not attend this session)
Ability to communicate	Ability to communicate Excellent	Ability to communicate Above average	Ability to communicate Average	Ability to communicate Below Average	Ability to communicate Poor	Ability to communicate N/A (Did not attend this session)
Clarity of materials	Clarity of materials Excellent	Clarity of materials Above average	Clarity of materials Average	Clarity of materials Below Average	Clarity of materials Poor	Clarity of materials N/A (Did not attend this session)
Relevance to my practice	Relevance to my practice Excellent	Relevance to my practice Above average	Relevance to my practice Average	Relevance to my practice Below Average	Relevance to my practice Poor	Relevance to my practice N/A (Did not attend this session)

Comments on speaker/presentation: if you sensed personal or commercial bias please list that here also.

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* 10. Small Group Discussion:
In- & Out-Patient Substance Abuse Counseling & Treatment | Steven Peterson, LCSW, CADCIII

	Excellent	Above average	Average	Below Average	Poor	N/A (Did not attend this session)
Topic knowledge	Topic knowledge Excellent	Topic knowledge Above average	Topic knowledge Average	Topic knowledge Below Average	Topic knowledge Poor	Topic knowledge N/A (Did not attend this session)
Ability to communicate	Ability to communicate Excellent	Ability to communicate Above average	Ability to communicate Average	Ability to communicate Below Average	Ability to communicate Poor	Ability to communicate N/A (Did not attend this session)
Clarity of materials	Clarity of materials Excellent	Clarity of materials Above average	Clarity of materials Average	Clarity of materials Below Average	Clarity of materials Poor	Clarity of materials N/A (Did not attend this session)
Relevance to my practice	Relevance to my practice Excellent	Relevance to my practice Above average	Relevance to my practice Average	Relevance to my practice Below Average	Relevance to my practice Poor	Relevance to my practice N/A (Did not attend this session)

Comments on speaker/presentation: if you sensed personal or commercial bias please list that here also.

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* 11. Small Group Discussion:
Hands on Learning About PEARLS Screening and ACEs in Teens with Role Play and Discussions | Miriam Rhew, MD, MPH, FAAP & Deirdre Bernard-Pearl, MD, FAAP

	Excellent	Above average	Average	Below Average	Poor	N/A (Did not attend this session)
Topic knowledge	Topic knowledge Excellent	Topic knowledge Above average	Topic knowledge Average	Topic knowledge Below Average	Topic knowledge Poor	Topic knowledge N/A (Did not attend this session)
Ability to communicate	Ability to communicate Excellent	Ability to communicate Above average	Ability to communicate Average	Ability to communicate Below Average	Ability to communicate Poor	Ability to communicate N/A (Did not attend this session)
Clarity of materials	Clarity of materials Excellent	Clarity of materials Above average	Clarity of materials Average	Clarity of materials Below Average	Clarity of materials Poor	Clarity of materials N/A (Did not attend this session)
Relevance to my practice	Relevance to my practice Excellent	Relevance to my practice Above average	Relevance to my practice Average	Relevance to my practice Below Average	Relevance to my practice Poor	Relevance to my practice N/A (Did not attend this session)

Comments on speaker/presentation: if you sensed personal or commercial bias please list that here also.

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* 12. Small Group Discussion:
Physician Wellness and Self-Care | Hailey Nelson, MD, FAAP, IBCLC

	Excellent	Above average	Average	Below Average	Poor	N/A (Did not attend this session)
Topic knowledge	Topic knowledge Excellent	Topic knowledge Above average	Topic knowledge Average	Topic knowledge Below Average	Topic knowledge Poor	Topic knowledge N/A (Did not attend this session)
Ability to communicate	Ability to communicate Excellent	Ability to communicate Above average	Ability to communicate Average	Ability to communicate Below Average	Ability to communicate Poor	Ability to communicate N/A (Did not attend this session)
Clarity of materials	Clarity of materials Excellent	Clarity of materials Above average	Clarity of materials Average	Clarity of materials Below Average	Clarity of materials Poor	Clarity of materials N/A (Did not attend this session)
Relevance to my practice	Relevance to my practice Excellent	Relevance to my practice Above average	Relevance to my practice Average	Relevance to my practice Below Average	Relevance to my practice Poor	Relevance to my practice N/A (Did not attend this session)

Comments on speaker/presentation: if you sensed personal or commercial bias please list that here also.

Questions 13-22 about program evaluation and outcome are required for our accreditation documentation, so please be sure to complete this section of the survey. Thank you!

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* 13. How well did the Adolescent Health CME Conference meet your educational expectations?

Exceeded Expectations

Met Expectations

Did NOT Meet Expectations

Exceeded Expectations

Met Expectations

Did NOT Meet Expectations

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* 14. Were the learning objectives of this CME activity achieved?

Yes

No

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* 15. Based on what you learned in this activity, do you plan to change:
(a) The strategies you implement in practice?

Yes

No

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* 16. Based on what you learned in this activity, do you plan to change:
(b) What you do in practice?

Yes

No

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* 17. If YES to either of the above questions, please identify any changes in practice that you plan to make:

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* 18. If NO and you do not plan to make changes in practice, other than lack of time and resources, why not? (select all that apply)

Systems-related barriers - please describe in text box below

The activity reinforced what I am already doing in practice

No practice changes were recommended

Changes were not appropriate options for my practice

Other - please describe in text box below

Please describe:

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* 19. On a scale of 1 to 7, what was the return on your investment of time/effort for participating in this activity?

1 (High Return)

2

3

4 (Medium Return)

5

6

7 (Low Return)

1 (High Return)

2

3

4 (Medium Return)

5

6

7 (Low Return)

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* 20. Do you feel a commercial product, device, or service was inappropriately promoted in the educational content?

Yes

No

If yes, please comment:

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* 21. Are you a member of NAPNAP (National Association of Pediatric Nurse Practitioners)?

Yes

No

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* 22. How would you rate your overall satisfaction with this CME activity?

Very Satisfied

Satisfied

Not Satisfied

Very Satisfied

Satisfied

Not Satisfied

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* 23. Would you recommend this activity to a colleague based on its impact on your practice/patient care?

Yes

No

Comments:

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* 24. On a scale of 1 to 7, what is the likelihood that what you learned in this activity will result in improvement
in your patients’ health status?

Highly Likely

Highly Unlikely

Highly Likely

Highly Unlikely

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* 25. Will you use the information you learned in this activity to enhance any of the following:

Team-based care

Interprofessional work

Community partnerships

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* 26. Which lecture did you find the most valuable?

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* 27. Which small group discussion did you find the most valuable?

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* 28. Do you have any other comments?

Thank you for completing the Program and Speaker Evaluation. Once your response has been registered you will receive your CME or CE certificate via the email address supplied on this survey.

For questions, please contact info@aapca1.org or call 916-274-4173.