Sample Needs Assessment Survey
We appreciate your involvement with our continuing education courses and would like to hear from you. Please
complete this questionnaire to let us know of your education needs.
1. Degree:
2. Specialty:
3. Most of the patients I see have problems in the following areas, so I would be interested in CME on these
topics:
4. List the two diagnoses/clinical problems you most frequently encounter:
5. What skills or procedures would you benefit from learning or reviewing?
6. What practice gaps, if any, have you observed among healthcare providers? (A practice gap is the difference
between actual and ideal performance. Professional practice gaps are measured in terms of: (1) Knowledge:
being aware of what to do, (2) Competence: being able to apply knowledge, skills, and judgment in practice‐
knowing how to do something, and (3) Performance: having the ability to implement the strategy or skill‐what
one actually does.)
7. Which of the following criteria do you use in choosing a CME Course?* (check all that apply)
New diagnostic approaches
New therapeutic and management approaches
New drugs and/or drug therapies
New procedures
Learn about new topics in my specialty
Practice management
Risk management
8. What areas of your continuing professional development are difficult to manage or resolve that you would
like to improve in general (e.g., assessment/diagnosis, legal issues, etc.)?