Clone of PIM Evaluation

Learning Objectives

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Learning Objective 1	Learning Objective 1 - Strongly Agree	Learning Objective 1 - Agree	Learning Objective 1 - Neutral	Learning Objective 1 - Disagree	Learning Objective 1 - Strongly Disagree
Learning Objective 2	Learning Objective 2 - Strongly Agree	Learning Objective 2 - Agree	Learning Objective 2 - Neutral	Learning Objective 2 - Disagree	Learning Objective 2 - Strongly Disagree
Learning Objective 3	Learning Objective 3 - Strongly Agree	Learning Objective 3 - Agree	Learning Objective 3 - Neutral	Learning Objective 3 - Disagree	Learning Objective 3 - Strongly Disagree
Learning Objective 4	Learning Objective 4 - Strongly Agree	Learning Objective 4 - Agree	Learning Objective 4 - Neutral	Learning Objective 4 - Disagree	Learning Objective 4 - Strongly Disagree
Learning Objective 5	Learning Objective 5 - Strongly Agree	Learning Objective 5 - Agree	Learning Objective 5 - Neutral	Learning Objective 5 - Disagree	Learning Objective 5 - Strongly Disagree

Based on your participation in this activity, choose the statements(s) that apply:

I gained new strategies/skills/information that I can apply to my area of practice.

I plan to implement new strategies/skills/information into my practice.

I need more information before I can implement new strategies/skills/information into my practice behavior.

This activity will not change my practice as my current practice is consistent with the information presented.

This activity will not change my practice, as I do not agree with the information presented.

What strategies/changes do you plan to implement into your practice?

How confident are you that you will be able to make your intended changes?

Very confident

Somewhat Confident

Unsure

Not very confident

What barriers do you see to making a change in your practice?

Speaker Effective in Presenting the Material

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Speaker 1	Speaker 1 - Strongly Agree	Speaker 1 - Agree	Speaker 1 - Neutral	Speaker 1 - Disagree	Speaker 1 - Strongly Disagree
Speaker 2	Speaker 2 - Strongly Agree	Speaker 2 - Agree	Speaker 2 - Neutral	Speaker 2 - Disagree	Speaker 2 - Strongly Disagree
Speaker 3	Speaker 3 - Strongly Agree	Speaker 3 - Agree	Speaker 3 - Neutral	Speaker 3 - Disagree	Speaker 3 - Strongly Disagree

Speaker Avoided Commercial Bias or Influence

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Speaker 1	Speaker 1 - Strongly Agree	Speaker 1 - Agree	Speaker 1 - Neutral	Speaker 1 - Disagree	Speaker 1 - Strongly Disagree
Speaker 2	Speaker 2 - Strongly Agree	Speaker 2 - Agree	Speaker 2 - Neutral	Speaker 2 - Disagree	Speaker 2 - Strongly Disagree
Speaker 3	Speaker 3 - Strongly Agree	Speaker 3 - Agree	Speaker 3 - Neutral	Speaker 3 - Disagree	Speaker 3 - Strongly Disagree

The content presentation:

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Enhanced my current knowledge base	Enhanced my current knowledge base - Strongly Agree	Enhanced my current knowledge base - Agree	Enhanced my current knowledge base - Neutral	Enhanced my current knowledge base - Disagree	Enhanced my current knowledge base - Strongly Disagree
Addressed my most pressing questions	Addressed my most pressing questions - Strongly Agree	Addressed my most pressing questions - Agree	Addressed my most pressing questions - Neutral	Addressed my most pressing questions - Disagree	Addressed my most pressing questions - Strongly Disagree
Promoted improvements or quality in healthcare	Promoted improvements or quality in healthcare - Strongly Agree	Promoted improvements or quality in healthcare - Agree	Promoted improvements or quality in healthcare - Neutral	Promoted improvements or quality in healthcare - Disagree	Promoted improvements or quality in healthcare - Strongly Disagree
Was scientifically rigorous and evidence based	Was scientifically rigorous and evidence based - Strongly Agree	Was scientifically rigorous and evidence based - Agree	Was scientifically rigorous and evidence based - Neutral	Was scientifically rigorous and evidence based - Disagree	Was scientifically rigorous and evidence based - Strongly Disagree
Avoided commercial bias or influence	Avoided commercial bias or influence - Strongly Agree	Avoided commercial bias or influence - Agree	Avoided commercial bias or influence - Neutral	Avoided commercial bias or influence - Disagree	Avoided commercial bias or influence - Strongly Disagree
Provided appropriate and effective opportunities for active learning (e.g., case studies, discussion, Q&A, etc.)	Provided appropriate and effective opportunities for active learning (e.g., case studies, discussion, Q&A, etc.) - Strongly Agree	Provided appropriate and effective opportunities for active learning (e.g., case studies, discussion, Q&A, etc.) - Agree	Provided appropriate and effective opportunities for active learning (e.g., case studies, discussion, Q&A, etc.) - Neutral	Provided appropriate and effective opportunities for active learning (e.g., case studies, discussion, Q&A, etc.) - Disagree	Provided appropriate and effective opportunities for active learning (e.g., case studies, discussion, Q&A, etc.) - Strongly Disagree

Handout materials were useful:

Yes

No

No handouts for this activity

Would you be willing to participate in a post-activity follow-up survey?

Yes

No

Please list any clinical issues/problems within your scope of practice you would like to see addressed in future educational activities:

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