CME Evaluation Form

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Department of Medicine

Divisions:

CME Evaluation Form

Medical Ground Rounds

Date«:

Name«:

GBMC Physician Number or Last 4 digits of SS#«:

(You must fill out and return to ensure a record of your CME credits that were earned. GBMC physicians, your signature and ID# on the sign-in sheet records your CME credits.) Please take a certificate of attendance for your records.

Please evaluate the speaker

Delivery of Presentation«:

4 - Excellent

3 - Good

2 - Fair

1 - Poor

Organization of Presentation«:

4 - Excellent

3 - Good

2 - Fair

1 - Poor

Visual Aids«:

4 - Excellent

3 - Good

2 - Fair

1 - Poor

Meets Educational Needs«:

4 - Excellent

3 - Good

2 - Fair

1 - Poor

Was the learning objective met?«:

[ Yes ] [ No ]

Please answer the following questions

What changes do you plan to make in your practice as a result of today's session?«:

What is the single most important piece of information you learned today?«:

What topics would you like to see covered in the future?«:

Did you feel the presentation was free from commercial bias? and if not, why?«:

Would you be willing to be contacted in the future regarding how this activity influenced your practice?«:

Would you like to receive the CME Calendar via email?«:

Please provide your email address«:

Fields marked with "«" are required.