Boca Raton Regional Hospital Internal Medicine Grand Rounds Evaluation Form - April 19

Please score your agreement with or assessment of the following questions and statements by rating on a scale of 1 to 5, with 5 representing the highest level of satisfaction or agreement. *

Scoring Key: 5=Strongly Agree 4=Agree 3=Neutral 2=Disagree 1=Strongly Disagree 0=Not applicable to my practice

	5	4	3	2	1	0
The information and/or skills learned will enhance my professional competence or ability.	The information and/or skills learned will enhance my professional competence or ability. - 5	The information and/or skills learned will enhance my professional competence or ability. - 4	The information and/or skills learned will enhance my professional competence or ability. - 3	The information and/or skills learned will enhance my professional competence or ability. - 2	The information and/or skills learned will enhance my professional competence or ability. - 1	The information and/or skills learned will enhance my professional competence or ability. - 0
This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients.	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 5	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 4	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 3	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 2	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 1	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 0

As a result of participating in this activity, to what extent do you agree that you will be better able to accomplish these objectives *

Scoring Key: 5=Strongly Agree 4=Agree 3=Neutral 2=Disagree 1=Strongly Disagree 0=Not applicable to my practice

	5	4	3	2	1	0
Use and apply risk stratification for cardiac events to your patients.	Use and apply risk stratification for cardiac events to your patients. - 5	Use and apply risk stratification for cardiac events to your patients. - 4	Use and apply risk stratification for cardiac events to your patients. - 3	Use and apply risk stratification for cardiac events to your patients. - 2	Use and apply risk stratification for cardiac events to your patients. - 1	Use and apply risk stratification for cardiac events to your patients. - 0
Appropriately screen for pulmonary diseases that can affect patients in the perioperative period.	Appropriately screen for pulmonary diseases that can affect patients in the perioperative period. - 5	Appropriately screen for pulmonary diseases that can affect patients in the perioperative period. - 4	Appropriately screen for pulmonary diseases that can affect patients in the perioperative period. - 3	Appropriately screen for pulmonary diseases that can affect patients in the perioperative period. - 2	Appropriately screen for pulmonary diseases that can affect patients in the perioperative period. - 1	Appropriately screen for pulmonary diseases that can affect patients in the perioperative period. - 0
Manage a patient with diabetes in the perioperative period.	Manage a patient with diabetes in the perioperative period. - 5	Manage a patient with diabetes in the perioperative period. - 4	Manage a patient with diabetes in the perioperative period. - 3	Manage a patient with diabetes in the perioperative period. - 2	Manage a patient with diabetes in the perioperative period. - 1	Manage a patient with diabetes in the perioperative period. - 0
Manage a patient on anticoagulation in the perioperative period.	Manage a patient on anticoagulation in the perioperative period. - 5	Manage a patient on anticoagulation in the perioperative period. - 4	Manage a patient on anticoagulation in the perioperative period. - 3	Manage a patient on anticoagulation in the perioperative period. - 2	Manage a patient on anticoagulation in the perioperative period. - 1	Manage a patient on anticoagulation in the perioperative period. - 0
Apply current recommendations to a patient, minimizing overuse.	Apply current recommendations to a patient, minimizing overuse. - 5	Apply current recommendations to a patient, minimizing overuse. - 4	Apply current recommendations to a patient, minimizing overuse. - 3	Apply current recommendations to a patient, minimizing overuse. - 2	Apply current recommendations to a patient, minimizing overuse. - 1	Apply current recommendations to a patient, minimizing overuse. - 0

Rate the Following *

Scoring Key: 5=Great Deal 4= A Good Bit 3=Some 2=Little 1=Very Little

	5	4	3	2	1
How much did you learn as a result of this CE program?	How much did you learn as a result of this CE program? - 5	How much did you learn as a result of this CE program? - 4	How much did you learn as a result of this CE program? - 3	How much did you learn as a result of this CE program? - 2	How much did you learn as a result of this CE program? - 1
How useful was the content of this CE program for your practice or other professional development?	How useful was the content of this CE program for your practice or other professional development? - 5	How useful was the content of this CE program for your practice or other professional development? - 4	How useful was the content of this CE program for your practice or other professional development? - 3	How useful was the content of this CE program for your practice or other professional development? - 2	How useful was the content of this CE program for your practice or other professional development? - 1

Rate the following *

Scoring Key: 5=Excellent 4=Very Good 3=Good 2=Fair 1=Poor

	5	4	3	2	1
Course content.	Course content. - 5	Course content. - 4	Course content. - 3	Course content. - 2	Course content. - 1
Speaker	Speaker - 5	Speaker - 4	Speaker - 3	Speaker - 2	Speaker - 1

Was this course fair, balanced and without commercial bias? *

Yes

No

If you checked "No,” please explain why: *

As a result of what was discussed at this activity what do you intend to do differently? Identify at least two learnings that could be incorporated into your practice *

What are the potential barriers or obstacles that might prevent you from implementing new strategies you learned at this activity? *

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Boca Raton Regional Hospital Internal Medicine Grand Rounds Evaluation Form - April 19