Boca Raton Regional Hospital Internal Medicine Grand Rounds Evaluation Form - Nov. 30

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
Describe current standards in breast cancer treatment.	Describe current standards in breast cancer treatment. - 5	Describe current standards in breast cancer treatment. - 4	Describe current standards in breast cancer treatment. - 3	Describe current standards in breast cancer treatment. - 2	Describe current standards in breast cancer treatment. - 1	Describe current standards in breast cancer treatment. - 0
Discuss common treatment side effects.	Discuss common treatment side effects. - 5	Discuss common treatment side effects. - 4	Discuss common treatment side effects. - 3	Discuss common treatment side effects. - 2	Discuss common treatment side effects. - 1	Discuss common treatment side effects. - 0
Examine pregnancy and fertility concerns in breast cancer patients.	Examine pregnancy and fertility concerns in breast cancer patients. - 5	Examine pregnancy and fertility concerns in breast cancer patients. - 4	Examine pregnancy and fertility concerns in breast cancer patients. - 3	Examine pregnancy and fertility concerns in breast cancer patients. - 2	Examine pregnancy and fertility concerns in breast cancer patients. - 1	Examine pregnancy and fertility concerns in breast cancer patients. - 0
Review breast cancer screening guidelines.	Review breast cancer screening guidelines. - 5	Review breast cancer screening guidelines. - 4	Review breast cancer screening guidelines. - 3	Review breast cancer screening guidelines. - 2	Review breast cancer screening guidelines. - 1	Review breast cancer screening guidelines. - 0
Identify survivorship issues after a breast cancer diagnosis.	Identify survivorship issues after a breast cancer diagnosis. - 5	Identify survivorship issues after a breast cancer diagnosis. - 4	Identify survivorship issues after a breast cancer diagnosis. - 3	Identify survivorship issues after a breast cancer diagnosis. - 2	Identify survivorship issues after a breast cancer diagnosis. - 1	Identify survivorship issues after a breast cancer diagnosis. - 0

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 - Nov. 30