Please rate the effectiveness of the faculty *

	High	Above Average	Average	Below Average	Low
Betsy B. Dokken, NP, PhD	Betsy B. Dokken, NP, PhD - High	Betsy B. Dokken, NP, PhD - Above Average	Betsy B. Dokken, NP, PhD - Average	Betsy B. Dokken, NP, PhD - Below Average	Betsy B. Dokken, NP, PhD - Low
Joyce A. Jackowski, MS, FNP-BC, AOCNP	Joyce A. Jackowski, MS, FNP-BC, AOCNP - High	Joyce A. Jackowski, MS, FNP-BC, AOCNP - Above Average	Joyce A. Jackowski, MS, FNP-BC, AOCNP - Average	Joyce A. Jackowski, MS, FNP-BC, AOCNP - Below Average	Joyce A. Jackowski, MS, FNP-BC, AOCNP - Low
Christine Cifranic, PA-C, MPAS	Christine Cifranic, PA-C, MPAS - High	Christine Cifranic, PA-C, MPAS - Above Average	Christine Cifranic, PA-C, MPAS - Average	Christine Cifranic, PA-C, MPAS - Below Average	Christine Cifranic, PA-C, MPAS - Low
Glenn J. Bingle, MD, PhD	Glenn J. Bingle, MD, PhD - High	Glenn J. Bingle, MD, PhD - Above Average	Glenn J. Bingle, MD, PhD - Average	Glenn J. Bingle, MD, PhD - Below Average	Glenn J. Bingle, MD, PhD - Low

As a result of participating in this activity, I am better able to *

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Discuss the relationship between type 2 diabetes mellitus and cancer: incidence, outcomes, and treatment-related hyperglycemia	Discuss the relationship between type 2 diabetes mellitus and cancer: incidence, outcomes, and treatment-related hyperglycemia - Strongly Agree	Discuss the relationship between type 2 diabetes mellitus and cancer: incidence, outcomes, and treatment-related hyperglycemia - Agree	Discuss the relationship between type 2 diabetes mellitus and cancer: incidence, outcomes, and treatment-related hyperglycemia - Neutral	Discuss the relationship between type 2 diabetes mellitus and cancer: incidence, outcomes, and treatment-related hyperglycemia - Disagree	Discuss the relationship between type 2 diabetes mellitus and cancer: incidence, outcomes, and treatment-related hyperglycemia - Strongly Disagree
Describe a rational approach to the clinical management of diabetes in the cancer patient	Describe a rational approach to the clinical management of diabetes in the cancer patient - Strongly Agree	Describe a rational approach to the clinical management of diabetes in the cancer patient - Agree	Describe a rational approach to the clinical management of diabetes in the cancer patient - Neutral	Describe a rational approach to the clinical management of diabetes in the cancer patient - Disagree	Describe a rational approach to the clinical management of diabetes in the cancer patient - Strongly Disagree
Define the appropriate imaging studies and laboratory workup for a patient with cardiac dysfunction related to Cancer therapy	Define the appropriate imaging studies and laboratory workup for a patient with cardiac dysfunction related to Cancer therapy - Strongly Agree	Define the appropriate imaging studies and laboratory workup for a patient with cardiac dysfunction related to Cancer therapy - Agree	Define the appropriate imaging studies and laboratory workup for a patient with cardiac dysfunction related to Cancer therapy - Neutral	Define the appropriate imaging studies and laboratory workup for a patient with cardiac dysfunction related to Cancer therapy - Disagree	Define the appropriate imaging studies and laboratory workup for a patient with cardiac dysfunction related to Cancer therapy - Strongly Disagree
Discuss the role of the AP in a interdisciplinary approach to the patient with cardiac comorbidities and Cancer therapy	Discuss the role of the AP in a interdisciplinary approach to the patient with cardiac comorbidities and Cancer therapy - Strongly Agree	Discuss the role of the AP in a interdisciplinary approach to the patient with cardiac comorbidities and Cancer therapy - Agree	Discuss the role of the AP in a interdisciplinary approach to the patient with cardiac comorbidities and Cancer therapy - Neutral	Discuss the role of the AP in a interdisciplinary approach to the patient with cardiac comorbidities and Cancer therapy - Disagree	Discuss the role of the AP in a interdisciplinary approach to the patient with cardiac comorbidities and Cancer therapy - Strongly Disagree
List three risk factors for the development of cognitive impairment in the patient receiving treatment for cancer	List three risk factors for the development of cognitive impairment in the patient receiving treatment for cancer - Strongly Agree	List three risk factors for the development of cognitive impairment in the patient receiving treatment for cancer - Agree	List three risk factors for the development of cognitive impairment in the patient receiving treatment for cancer - Neutral	List three risk factors for the development of cognitive impairment in the patient receiving treatment for cancer - Disagree	List three risk factors for the development of cognitive impairment in the patient receiving treatment for cancer - Strongly Disagree
Describe two methods of assessment for cognitive impairment in the patient receiving treatment for cancer	Describe two methods of assessment for cognitive impairment in the patient receiving treatment for cancer - Strongly Agree	Describe two methods of assessment for cognitive impairment in the patient receiving treatment for cancer - Agree	Describe two methods of assessment for cognitive impairment in the patient receiving treatment for cancer - Neutral	Describe two methods of assessment for cognitive impairment in the patient receiving treatment for cancer - Disagree	Describe two methods of assessment for cognitive impairment in the patient receiving treatment for cancer - Strongly Disagree

Please rate your level of agreement with the following statements *

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
This activity met my educational needs, expectations, and objectives	This activity met my educational needs, expectations, and objectives - Strongly Agree	This activity met my educational needs, expectations, and objectives - Agree	This activity met my educational needs, expectations, and objectives - Neutral	This activity met my educational needs, expectations, and objectives - Disagree	This activity met my educational needs, expectations, and objectives - Strongly Disagree
This activity was relevant to my practice	This activity was relevant to my practice - Strongly Agree	This activity was relevant to my practice - Agree	This activity was relevant to my practice - Neutral	This activity was relevant to my practice - Disagree	This activity was relevant to my practice - Strongly Disagree
I feel confident treating patients in my practice based on this activity	I feel confident treating patients in my practice based on this activity - Strongly Agree	I feel confident treating patients in my practice based on this activity - Agree	I feel confident treating patients in my practice based on this activity - Neutral	I feel confident treating patients in my practice based on this activity - Disagree	I feel confident treating patients in my practice based on this activity - Strongly Disagree
This activity rates highly in comparison with other CE/CME activities in which I have participated in the last 12 months	This activity rates highly in comparison with other CE/CME activities in which I have participated in the last 12 months - Strongly Agree	This activity rates highly in comparison with other CE/CME activities in which I have participated in the last 12 months - Agree	This activity rates highly in comparison with other CE/CME activities in which I have participated in the last 12 months - Neutral	This activity rates highly in comparison with other CE/CME activities in which I have participated in the last 12 months - Disagree	This activity rates highly in comparison with other CE/CME activities in which I have participated in the last 12 months - Strongly Disagree
There is a continuing need for education on this topic	There is a continuing need for education on this topic - Strongly Agree	There is a continuing need for education on this topic - Agree	There is a continuing need for education on this topic - Neutral	There is a continuing need for education on this topic - Disagree	There is a continuing need for education on this topic - Strongly Disagree
The presentation was scientifically sound and free of commercial bias or influence	The presentation was scientifically sound and free of commercial bias or influence - Strongly Agree	The presentation was scientifically sound and free of commercial bias or influence - Agree	The presentation was scientifically sound and free of commercial bias or influence - Neutral	The presentation was scientifically sound and free of commercial bias or influence - Disagree	The presentation was scientifically sound and free of commercial bias or influence - Strongly Disagree

If you thought the presentations were commercially biased, please explain

Of all of the patients that you see per month, how many are likely to be impacted by the information that you acquired in this CE/CME activity? (example: 50) *

For you, was the educational level of this activity *

Too basic

Appropriate

Too advanced

Based upon your participation in this activity, choose the statements that apply *

I plan to implement new strategies/ skills/ information

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

I need more information before I can implement new strategies/ skills/ information

My current practice is consistent with the information presented

This topic is not within my scope of practice

I do not agree with the information presented

What, if any, additional changes do you plan to implement into your practice?

My confidence level in being able to implement these changes is *

Very confident

Somewhat confident

Uncertain

Little confidence

No confidence

Not applicable

If you consider a change in practice, please check any barriers to overcome before initiating that change *

Organizational constraints

Formulary issues

Patient reluctance to change

Patient nonadherence

Insufficient time

Financial/Insurance

Do not know enough about the recommendations to change yet

What still remains unanswered for you?

Additional comments

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