EVALUATION
IN ORDER TO ASSIST YOU IN MAKING THIS LEARNING ACTIVITY OF MORE VALUE, WE ASK
THAT YOU COMPLETE THE EVALUATION FORM BELOW
1. Overall Activity Rating:
2. Were the educational objectives met:
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
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Poor 1
Fair 2
Not at All
1
Good 3
2
3
Very Good 4
4
Excellent 5
5 A Great Deal
Explain new techniques relevant to the topic
Recognize relevant research and quality care issues
Discuss basic and updated information
Discuss the pathogenesis of the disease state represented by the conference
3. Overall Speaker Rating
Poor 1
Fair 2
Good 3
Very Good 4
Excellent 5
4. Where do you have problems in your practice?
5. Please give an example of what you will do differently in your practice as a result of participating in this activity:
6. Did you feel that this activity was balanced, fair and free of commercial bias?
If No, please explain:
No
Yes
6. Please list suggestions for future CME/CE programs:
8.
Comments:
The University of Arizona College of Medicine at the Arizona Health Sciences Center is accredited by the Accreditation Council for Continuing Medical Education to
provide continuing medical education for physicians.
The University of Arizona College of Medicine at the Arizona Health Sciences Center designates this educational activity for a maximum of 1.0 AMA/PRA Category 1
Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.
Sponsored by the University of Arizona College of Medicine at the Arizona Health Sciences Center
Name:
Date:
Address:
Email:
Phone:
Name/Date of Grand Round:
Speaker:
Topic:
Please fax to: Kathy Fisher, Continuing Medical Education, 520-626-2427