Boca Raton Regional Hospital Internal Medicine Grand Rounds Evaluation Form - Jan 11

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
Define trauma and the psychological sequela following traumatic events.	Define trauma and the psychological sequela following traumatic events. - 5	Define trauma and the psychological sequela following traumatic events. - 4	Define trauma and the psychological sequela following traumatic events. - 3	Define trauma and the psychological sequela following traumatic events. - 2	Define trauma and the psychological sequela following traumatic events. - 1	Define trauma and the psychological sequela following traumatic events. - 0
Describe military culture and the impact of PTSD on physical/emotional health and help-seeking behaviors.	Describe military culture and the impact of PTSD on physical/emotional health and help-seeking behaviors. - 5	Describe military culture and the impact of PTSD on physical/emotional health and help-seeking behaviors. - 4	Describe military culture and the impact of PTSD on physical/emotional health and help-seeking behaviors. - 3	Describe military culture and the impact of PTSD on physical/emotional health and help-seeking behaviors. - 2	Describe military culture and the impact of PTSD on physical/emotional health and help-seeking behaviors. - 1	Describe military culture and the impact of PTSD on physical/emotional health and help-seeking behaviors. - 0
Identify treatment options to reduce PTSD symptoms.	Identify treatment options to reduce PTSD symptoms. - 5	Identify treatment options to reduce PTSD symptoms. - 4	Identify treatment options to reduce PTSD symptoms. - 3	Identify treatment options to reduce PTSD symptoms. - 2	Identify treatment options to reduce PTSD symptoms. - 1	Identify treatment options to reduce PTSD symptoms. - 0
Examine ways to incorporate trauma informed care in the medical setting.	Examine ways to incorporate trauma informed care in the medical setting. - 5	Examine ways to incorporate trauma informed care in the medical setting. - 4	Examine ways to incorporate trauma informed care in the medical setting. - 3	Examine ways to incorporate trauma informed care in the medical setting. - 2	Examine ways to incorporate trauma informed care in the medical setting. - 1	Examine ways to incorporate trauma informed care in the medical setting. - 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 - Jan 11