Please rate the effectiveness of the faculty *

	High	Above Average	Average	Below Average	Low
Sandra Kurtin, RN, MS, AOCN, ANP-C	Sandra Kurtin, RN, MS, AOCN, ANP-C - High	Sandra Kurtin, RN, MS, AOCN, ANP-C - Above Average	Sandra Kurtin, RN, MS, AOCN, ANP-C - Average	Sandra Kurtin, RN, MS, AOCN, ANP-C - Below Average	Sandra Kurtin, RN, MS, AOCN, ANP-C - Low
Paige Goforth, MMS, PA-C	Paige Goforth, MMS, PA-C - High	Paige Goforth, MMS, PA-C - Above Average	Paige Goforth, MMS, PA-C - Average	Paige Goforth, MMS, PA-C - Below Average	Paige Goforth, MMS, PA-C - Low
Lisa M. Stringer, MSN, RN, ACNP-BC	Lisa M. Stringer, MSN, RN, ACNP-BC - High	Lisa M. Stringer, MSN, RN, ACNP-BC - Above Average	Lisa M. Stringer, MSN, RN, ACNP-BC - Average	Lisa M. Stringer, MSN, RN, ACNP-BC - Below Average	Lisa M. Stringer, MSN, RN, ACNP-BC - Low

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

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Demonstrate the recommended procedure for bone marrow biopsy including patient preparation, obtaining an adequate specimen, specimen processing for specific disorders, and post procedure education.	Demonstrate the recommended procedure for bone marrow biopsy including patient preparation, obtaining an adequate specimen, specimen processing for specific disorders, and post procedure education. - Strongly Agree	Demonstrate the recommended procedure for bone marrow biopsy including patient preparation, obtaining an adequate specimen, specimen processing for specific disorders, and post procedure education. - Agree	Demonstrate the recommended procedure for bone marrow biopsy including patient preparation, obtaining an adequate specimen, specimen processing for specific disorders, and post procedure education. - Neutral	Demonstrate the recommended procedure for bone marrow biopsy including patient preparation, obtaining an adequate specimen, specimen processing for specific disorders, and post procedure education. - Disagree	Demonstrate the recommended procedure for bone marrow biopsy including patient preparation, obtaining an adequate specimen, specimen processing for specific disorders, and post procedure education. - Strongly Disagree
Demonstrate techniques for Intrathecal chemotherapy administration (lumbar puncture and accessing an Ommaya reservoir) including patient preparation, obtaining adequate specimen, specimen processing for specific disorders, and post procedure education.	Demonstrate techniques for Intrathecal chemotherapy administration (lumbar puncture and accessing an Ommaya reservoir) including patient preparation, obtaining adequate specimen, specimen processing for specific disorders, and post procedure education. - Strongly Agree	Demonstrate techniques for Intrathecal chemotherapy administration (lumbar puncture and accessing an Ommaya reservoir) including patient preparation, obtaining adequate specimen, specimen processing for specific disorders, and post procedure education. - Agree	Demonstrate techniques for Intrathecal chemotherapy administration (lumbar puncture and accessing an Ommaya reservoir) including patient preparation, obtaining adequate specimen, specimen processing for specific disorders, and post procedure education. - Neutral	Demonstrate techniques for Intrathecal chemotherapy administration (lumbar puncture and accessing an Ommaya reservoir) including patient preparation, obtaining adequate specimen, specimen processing for specific disorders, and post procedure education. - Disagree	Demonstrate techniques for Intrathecal chemotherapy administration (lumbar puncture and accessing an Ommaya reservoir) including patient preparation, obtaining adequate specimen, specimen processing for specific disorders, and post procedure education. - Strongly Disagree
Demonstrate techniques for punch biopsy and suture techniques, including patient preparation, obtaining an adequate specimen, specimen processing for specific disorders, and post procedure education.	Demonstrate techniques for punch biopsy and suture techniques, including patient preparation, obtaining an adequate specimen, specimen processing for specific disorders, and post procedure education. - Strongly Agree	Demonstrate techniques for punch biopsy and suture techniques, including patient preparation, obtaining an adequate specimen, specimen processing for specific disorders, and post procedure education. - Agree	Demonstrate techniques for punch biopsy and suture techniques, including patient preparation, obtaining an adequate specimen, specimen processing for specific disorders, and post procedure education. - Neutral	Demonstrate techniques for punch biopsy and suture techniques, including patient preparation, obtaining an adequate specimen, specimen processing for specific disorders, and post procedure education. - Disagree	Demonstrate techniques for punch biopsy and suture techniques, including patient preparation, obtaining an adequate specimen, specimen processing for specific disorders, and post procedure education. - 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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