Program Evaluation

Please take a few moments to answer the following questions, which will be used to assist us in meeting your educational needs. Your feedback will be kept private and confidential and only aggregate data will be shared. On behalf of the RI Geriatric Education Center, we thank you!

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* 1. What was the purpose for your participation in this activity?

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* 2. What is your primary professional discipline? 

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* 3. Please list all professional license/certificate/degree(s) you hold:

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* 4. How satisfied with the activity were you overall?

EVALUATION OF TRAINING:
Please use the scale below to rate the efficacy of the learning objectives, the presenters, and the instructional format:
        1=Totally ineffective    2=Somewhat ineffective     3=Somewhat effective    4=Effective    5=Highly effective

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* 5. How effective was the activity in meeting the stated learning objectives?   
     Upon completion of this activity, participants will be able to:

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Totally ineffective 		2 3 4 5
Highly effective
Describe the components of geriatric assessment.
Explain geriatric assessment tools, and how they can be applied in a primary care setting
Identify geriatric assessment tools for patients who would benefit from additional evaluation.
Identify resources for patients and caregivers based on the results of a geriatric assessment

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* 6. Rate the effectiveness of the presenter. 
 Consider presentation style, knowledge of subject, quality of material, and practical applicability or relevance of topic in your assessment. 

  1
Totally ineffective 		2 3 4 5
Highly effective
Mary Beth Welesko, MS, APRN-CNP, FNP-BC, GNP-BC, ACHPN, WCC
Ana Tuya Fulton, MD, FACP

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* 7. Rate the effectiveness of teaching strategies:

  1
Totally ineffective 		2 3 4 5
Highly effective
Teaching strategies:

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* 8. What was the most significant thing(s) you learned as a result of participating in this activity?

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* 9. In your work with older adults, do you intent to implement at least one practice improvement learned as a result of this activity?

RETROSPECTIVE ASSESSMENT:

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* 10. Please indicate your perceived level of knowledge for each items listed below 1.) BEFORE completing the activity, and 2.) AFTER completing the activity. Rating Scale: 0% to 100% (no knowledge at all ... to most knowledge possible)

  BEFORE AFTER
 Describe the components of geriatric assessment.
Explain geriatric assessment tools, and how they can be applied in a primary care setting
Identify geriatric assessment tools for patients who would benefit from additional evaluation.
Identify resources for patients and caregivers based on the results of a geriatric assessment

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* 11. Please indicate your perceived level of confidence to apply each of the items listed below 1.) BEFORE completing this activity and 2.) AFTER completing the activity.   Rating Scale: 0% to 100% (no confidence at all... to most confidence possible)

  BEFORE AFTER
Describe the components of geriatric assessment.
Explain geriatric assessment tools, and how they can be applied in a primary care setting
Identify geriatric assessment tools for patients who would benefit from additional evaluation.
Identify resources for patients and caregivers based on the results of a geriatric assessment

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* 12. Please feel free to share any additional comments and suggestions. Your feedback is extremely valuable to us. 

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* 13. Please indicate your preferred completion certificate:

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* 14. Please complete the information below so we may send your certificate:

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