Required Questions For Participant Exit Evaluation

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Required Questions for Participant Exit Evaluation
1) Did this activity meet the learning objectives?
O Yes
O No
2) I have obtained new information (knowledge) as a result of attending this activity?
O Yes
O No
a.
If yes, from the information presented at this activity please identify the most valuable topic:
______________________________________________________________________________________________________
____________________________________________________________________________________________________
b. If no, was the activity description, objectives or goals misleading?
______________________________________________________________________________________________________
____________________________________________________________________________________________________
3) This activity will impact my competency (skills/abilities/strategies gained from the new information)? O Yes O No
a.
If yes, please describe what skills/abilities/strategies you have you gained from the information presented:
______________________________________________________________________________________________________
____________________________________________________________________________________________________
b. If no, please explain:
______________________________________________________________________________________________________
___________________________________________________________________________________________________
4) This activity will impact my performance (implementing the new skills/abilities/strategies):
O Yes
O No
a.
If yes, please list one skill/ability/strategy do you plan to implement in your practice:
______________________________________________________________________________________________________
____________________________________________________________________________________________________
b.
If no, please identify the barriers you perceive for implementing these changes:
O
Cost
O
Lack of time to assess/ counsel patients
O
Lack of administrative support / resources
O
Insurance / Reimbursement Issues
O
Patient Compliance Issues
O
Lack of consensus or professional guidelines
O
Other, please explain:
5) The skills/abilities/strategies I’ve obtained at this activity potentially will affect my patient’s outcomes?
O Yes O No
a.
If yes, please describe how those abilities/skills/strategies will affect your patient’s outcomes?
______________________________________________________________________________________________________
____________________________________________________________________________________________________
b. If no, please explain:
______________________________________________________________________________________________________
____________________________________________________________________________________________________
6) Was the overall activity presented without evidence of commercial bias or influence?
O Yes O No
If no, please identify the area that you believed to be biased.
____________________________________________________________________________________________________________
______________________________________________________________________________________________
7) What patient problems (or challenges) are you encountering that you feel you are not addressing to your satisfaction?
__________________________________________________________________________________________________________
________________________________________________________________________________________________

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