Boca Raton Regional Hospital Internal Medicine Grand Rounds Evaluation Form - Jan 18

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
Discuss the scope of HPV-related Gynecologic Cancers both in US and worldwide.	Discuss the scope of HPV-related Gynecologic Cancers both in US and worldwide. - 5	Discuss the scope of HPV-related Gynecologic Cancers both in US and worldwide. - 4	Discuss the scope of HPV-related Gynecologic Cancers both in US and worldwide. - 3	Discuss the scope of HPV-related Gynecologic Cancers both in US and worldwide. - 2	Discuss the scope of HPV-related Gynecologic Cancers both in US and worldwide. - 1	Discuss the scope of HPV-related Gynecologic Cancers both in US and worldwide. - 0
Review current recommendations for Cervical Cancer Screening in the US.	Review current recommendations for Cervical Cancer Screening in the US. - 5	Review current recommendations for Cervical Cancer Screening in the US. - 4	Review current recommendations for Cervical Cancer Screening in the US. - 3	Review current recommendations for Cervical Cancer Screening in the US. - 2	Review current recommendations for Cervical Cancer Screening in the US. - 1	Review current recommendations for Cervical Cancer Screening in the US. - 0
Explain the impact of HPV vaccination on Cervical Dysplasia and Cervical Cancer.	Explain the impact of HPV vaccination on Cervical Dysplasia and Cervical Cancer. - 5	Explain the impact of HPV vaccination on Cervical Dysplasia and Cervical Cancer. - 4	Explain the impact of HPV vaccination on Cervical Dysplasia and Cervical Cancer. - 3	Explain the impact of HPV vaccination on Cervical Dysplasia and Cervical Cancer. - 2	Explain the impact of HPV vaccination on Cervical Dysplasia and Cervical Cancer. - 1	Explain the impact of HPV vaccination on Cervical Dysplasia and Cervical Cancer. - 0
Examine current optimal treatment protocols for cervical, vulvar and vaginal cancers.	Examine current optimal treatment protocols for cervical, vulvar and vaginal cancers. - 5	Examine current optimal treatment protocols for cervical, vulvar and vaginal cancers. - 4	Examine current optimal treatment protocols for cervical, vulvar and vaginal cancers. - 3	Examine current optimal treatment protocols for cervical, vulvar and vaginal cancers. - 2	Examine current optimal treatment protocols for cervical, vulvar and vaginal cancers. - 1	Examine current optimal treatment protocols for cervical, vulvar and vaginal cancers. - 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 18