Please rate the effectiveness of the faculty *

	High	Above Average	Average	Below Average	Low
Anthony J. Olsznaski, MD, RPH	Anthony J. Olsznaski, MD, RPH - High	Anthony J. Olsznaski, MD, RPH - Above Average	Anthony J. Olsznaski, MD, RPH - Average	Anthony J. Olsznaski, MD, RPH - Below Average	Anthony J. Olsznaski, MD, RPH - Low
Brianna Hoffner, MS, ANP-BC, AOCNP	Brianna Hoffner, MS, ANP-BC, AOCNP - High	Brianna Hoffner, MS, ANP-BC, AOCNP - Above Average	Brianna Hoffner, MS, ANP-BC, AOCNP - Average	Brianna Hoffner, MS, ANP-BC, AOCNP - Below Average	Brianna Hoffner, MS, ANP-BC, AOCNP - Low

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

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Describe the mechanism of action for talimogne laherparepvec (T-VEC)	Describe the mechanism of action for talimogne laherparepvec (T-VEC) - Strongly Agree	Describe the mechanism of action for talimogne laherparepvec (T-VEC) - Agree	Describe the mechanism of action for talimogne laherparepvec (T-VEC) - Neutral	Describe the mechanism of action for talimogne laherparepvec (T-VEC) - Disagree	Describe the mechanism of action for talimogne laherparepvec (T-VEC) - Strongly Disagree
Describe how checkpoint inhibitors, both CTLA-4 and PD-L1, alter the body’s immune response to melanoma cells	Describe how checkpoint inhibitors, both CTLA-4 and PD-L1, alter the body’s immune response to melanoma cells - Strongly Agree	Describe how checkpoint inhibitors, both CTLA-4 and PD-L1, alter the body’s immune response to melanoma cells - Agree	Describe how checkpoint inhibitors, both CTLA-4 and PD-L1, alter the body’s immune response to melanoma cells - Neutral	Describe how checkpoint inhibitors, both CTLA-4 and PD-L1, alter the body’s immune response to melanoma cells - Disagree	Describe how checkpoint inhibitors, both CTLA-4 and PD-L1, alter the body’s immune response to melanoma cells - Strongly Disagree
Describe potential toxicities associated with checkpoint inhibitors, including etiology of these toxicities and management and/or prophylaxis	Describe potential toxicities associated with checkpoint inhibitors, including etiology of these toxicities and management and/or prophylaxis - Strongly Agree	Describe potential toxicities associated with checkpoint inhibitors, including etiology of these toxicities and management and/or prophylaxis - Agree	Describe potential toxicities associated with checkpoint inhibitors, including etiology of these toxicities and management and/or prophylaxis - Neutral	Describe potential toxicities associated with checkpoint inhibitors, including etiology of these toxicities and management and/or prophylaxis - Disagree	Describe potential toxicities associated with checkpoint inhibitors, including etiology of these toxicities and management and/or prophylaxis - Strongly Disagree
Explain how checkpoint inhibitors differ from other available treatment options for metastatic melanoma, including kinase inhibitors and cytotoxic chemotherapy	Explain how checkpoint inhibitors differ from other available treatment options for metastatic melanoma, including kinase inhibitors and cytotoxic chemotherapy - Strongly Agree	Explain how checkpoint inhibitors differ from other available treatment options for metastatic melanoma, including kinase inhibitors and cytotoxic chemotherapy - Agree	Explain how checkpoint inhibitors differ from other available treatment options for metastatic melanoma, including kinase inhibitors and cytotoxic chemotherapy - Neutral	Explain how checkpoint inhibitors differ from other available treatment options for metastatic melanoma, including kinase inhibitors and cytotoxic chemotherapy - Disagree	Explain how checkpoint inhibitors differ from other available treatment options for metastatic melanoma, including kinase inhibitors and cytotoxic chemotherapy - Strongly Disagree
Discuss the role of the advanced practitioner as part of the collaborative practice team in caring for patients on immunotherapy treatments	Discuss the role of the advanced practitioner as part of the collaborative practice team in caring for patients on immunotherapy treatments - Strongly Agree	Discuss the role of the advanced practitioner as part of the collaborative practice team in caring for patients on immunotherapy treatments - Agree	Discuss the role of the advanced practitioner as part of the collaborative practice team in caring for patients on immunotherapy treatments - Neutral	Discuss the role of the advanced practitioner as part of the collaborative practice team in caring for patients on immunotherapy treatments - Disagree	Discuss the role of the advanced practitioner as part of the collaborative practice team in caring for patients on immunotherapy treatments - 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
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

For you, was the educational level of this activity *

Too basic

Appropriate

Too advanced

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) *

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

Leave this field blank