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CME EVALUATION FORM

PRE-TEST:

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POST-TEST:

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Date
Month
Day
Year

LEARNER SURVEY

Please rate the impact of the following objectives:

As a result of attending this activity, I am better able to:

1. Discuss and explain the etiologies of ....
2. Diagnose different complications of the condition.
3. Apply updated therapies to specific clinical cases.

1. Please rate the projected impact of this activity on your knowledge, competence, performance, and patient

outcomes*: competence is defined as the ability to apply knowledge, skills, and judgment in practice (knowing how to do something).

This activity increased my knowledge.
This activity increased my competence.
This activity improved my performance.
This activity will improve my patient outcomes.

*Medical Society of New Jersey requires that we analyze changes in learners’ competence, performance, or patient outcomes.

3. Will you attempt to address these barriers in order to implement changes in your competence, performance, and/or patients’ outcomes?
N/A
No
Yes
5. Overall, were the speakers knowledgeable regarding the content? (copy)
Yes
No
6. Overall, was the presentation balanced, objective, and scientifically rigorous?
Yes
No
7. Was there an opportunity to discuss practice-relevant issues with the speaker?
Yes
No
9. Do you feel the activity was scientifically sound and free of commercial bias* or influence?
Yes
No

*Commercial bias is defined as a personal judgment in favor of a specific product or service of a commercial interest.

10. Speaker’s disclosure was communicated verbally or in writing
Yes
No
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