CASE CONFERENCE – TUMOR BOARD (RSS)
EVALUATION FORM
Greensboro AHEC CME
1200 N Elm Street/Greensboro, NC 27401 / 336.832.8219
www.gahec.org/cme
Please take a few moments to complete this form. We value your opinions, as they will ensure continuing course relevance and
quality. Thank you for your assistance.
Series Title:
Session Date(s):
Please answer the following questions:
1. As a result of viewing and discussing cases, list an example of something that you have learned that you may be able to
apply or use in your practice setting. ________________________________________________________________
_______________________________________________________________________________________________
2. Identify barriers you might encounter when implementing the new information or techniques in your practice?
cost
lack of experience
lack of administrative support
patient compliance issues
lack of opportunity (patients)
lack of resources (equipment)
lack of time to assess/counsel patients
lack of consensus or professional guidelines
reimbursement/insurance issues
no barriers
other __________________________________________________________________________________________
3. How will you overcome these barriers? _____________________________________________________________
______________________________________________________________________________________________
Response Codes:
1=Strongly Disagree 2=Disagree 3=Undecided 4=Agree 5=Strongly Agree
Please indicate if your participation in the conference helped you to accomplish the following objectives:
<Insert Objective 1 here>
1
2
3
4
5
<Insert Objective 2 here>
1
2
3
4
5
<Insert Objective 3 here>
1
2
3
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5
<Insert Objective 4 here>
1
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5
This activity conveyed information that applies to my current (or potential) scope of practice.
Yes
No
This activity conveyed information which will assist me in improving the health of my patients.
Yes
No
The style and format of the presentation was appropriate for the content presented.
Yes
No
Was commercial support and potential faculty conflict-of-interest conveyed to the audience prior to the
activity?
Yes
No
The presentation was free of commercial bias.
Yes
No
All the recommendations involving clinical medicine was based on evidence that is accepted within the
profession of medicine as adequate justification for indications and contraindications in the care of
patients.
Yes
No
All scientific research referred to, reported or used to support or justification of a patient care
recommendation conformed to the generally accepted standards of experimental design, data collection
and analysis.
Yes
No
5. Based on your educational needs, list future CME topics. ________________________________________________
Are you:
Physician________________________ or
Other_________________________
(Specialty)
(Specify)
POLICY ON FACULTY AND SPONSOR DISCLOSURE: The Greensboro AHEC adheres to the ACCME Standards regarding industry support
of continuing medical education. Disclosure of faculty and commercial support relationships, if any, will be made know at this activity.