PROGRAM EVALUATION FORM
Program Title
Program Date
Please take a moment to complete the evaluation form on the sessions you attended today. Your feedback is vital to
the planning and execution of our ongoing CME programs and we greatly value your input. Thank you!
Hip Arthroscopy in the Skeletally Immature Athlete; Michael Shingles, D.O.
Objectives: Review, evaluation and treatment of pediatric hip pathology
Excellent
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Poor
Was the speaker well prepared and organized?
Were the speaker’s objectives met?
Was the content of the lecture educational and useful?
Did the lecture increase your knowledge base?
Did this activity promote the practice of evidence-based medicine?
Comments? __________________________________________________________________________________________________________________________________
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Articular Cartilage Injuries in Pediatric Patients; Andrew Schorfhaar, D.O.
Objectives: Proper history-taking and physical exam skills, understanding staging and treatment protocols
Excellent
Good
Fair
Was the speaker well prepared and organized?
Were the speaker’s objectives met?
Was the content of the lecture educational and useful?
Did the lecture increase your knowledge base?
Did this activity promote the practice of evidence-based medicine?
Poor
Comments? __________________________________________________________________________________________________________________________________
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Shoulder Concerns; Douglas Dietzel, D.O.; Objectives: Knowledge of growth plate muscle differences, training and overuse
Excellent
Good
Fair
Poor
Was the speaker well prepared and organized?
Were the speaker’s objectives met?
Was the content of the lecture educational and useful?
Did the lecture increase your knowledge base?
Did this activity promote the practice of evidence-based medicine?
Comments? __________________________________________________________________________________________________________________________________
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Medical Concerns in the Pediatric Athlete; Brooke Lemmen, D.O., A.T.C.; Objectives: (1) Outline return to play
recommendations for an athlete with mononucleosis (2)Distinguish the components of the “Female Athlete Triad”, identify
the main problem and develop a plan to address it (3) Identify cardiac risk factors in pediatric athletes
Excellent
Good
Fair
Poor
Was the speaker well prepared and organized?
Were the speaker’s objectives met?
Was the content of the lecture educational and useful?
Did the lecture increase your knowledge base?
Did this activity promote the practice of evidence-based medicine?
Comments? __________________________________________________________________________________________________________________________________
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Continued 
Apophysitis in the Pediatric/Adolescent Athlete; Joshua Takagishi, M.D., F.A.A.P., C.A.Q.S.M.
Objectives: (1) Review the current definition of an apophysis and an apophysitis injury (2) Understand the pathophysiology
behind an apophysitis (3) Identify the contributing factors to developing an apophysitis (4) Review the signs and symptoms of
an apophysitis (5) Discuss diagnosis and treatment of the different apophysitis injuries in the lower extremity, upper
extremity and back
Excellent
Good
Fair
Poor
Was the speaker well prepared and organized?
Were the speaker’s objectives met?
Was the content of the lecture educational and useful?
Did the lecture increase your knowledge base?
Did this activity promote the practice of evidence-based medicine?
Comments? __________________________________________________________________________________________________________________________________
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Growth Plate Injuries; Jeffrey Kovan, D.O.; Objectives: (1) Identify the common growth plate fractures in children and
adolescents (2) Understand treatment options for growth plate fractures
Excellent
Good
Fair
Poor
Was the speaker well prepared and organized?
Were the speaker’s objectives met?
Was the content of the lecture educational and useful?
Did the lecture increase your knowledge base?
Did this activity promote the practice of evidence-based medicine?
Comments? __________________________________________________________________________________________________________________________________
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Radiology Findings Compares to Surgical Findings: Case Studies Review
Douglas Dietzel, D.O., A.T.C.; Andrew Schorfhaar, D.O.; Michael Shingles, D.O.; Michael Straus, P.A.-C., A.T.C., MMSc
Objectives: Learning radiologic testing and evaluation for specific pediatric cases
Excellent
Good
Fair
Poor
Were the speaker’s well prepared and organized?
Were the speaker’s objectives met?
Was the content of the lecture educational and useful?
Did the lecture increase your knowledge base?
Did this activity promote the practice of evidence-based medicine?
Comments? __________________________________________________________________________________________________________________________________
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Concussion Evaluation and Management; Jamie Chioini, D.O.; Jeffrey Kovan, D.O.; Brooke Lemmen, D.O., A.T.C.
Objectives: (1) Understand the common clinical findings seen in the concussed athlete (2) Develop a better understanding of
the neuropsuychological examination in the concussed athlete (3) Understand the use of ImPACT testing in recognizing
concussion and it's role in return to play
Excellent
Good
Fair
Poor
Were the speaker’s well prepared and organized?
Were the speaker’s objectives met?
Was the content of the lecture educational and useful?
Did the lecture increase your knowledge base?
Did this activity promote the practice of evidence-based medicine?
Comments? __________________________________________________________________________________________________________________________________
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Musculoskeletal Ultrasound; Larry Nassar, D.O., A.T.C., F.A.O.A.S.M.; Ryan Niehaus, D.O.; Robert Norris, M.D.; Joshua
Takagishi, M.D., F.A.A.P., C.A.Q.S.M.; Objectives: Introduction to ultrasound including; example, scanning and demonstration
of ultrasound guided injection technique
Excellent
Good
Fair
Poor
Were the speaker’s well prepared and organized?
Were the speaker’s objectives met?
Was the content of the lecture educational and useful?
Did the lecture increase your knowledge base?
Did this activity promote the practice of evidence-based medicine?
Comments? _________________________________________________________________________________________________________________________________