Family Medicine Residency Faculty Development Evaluation

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 NA=Not applicable to my practice

	5	4	3	2	1	NA
The skills learned in this CME course enhanced my professional competence.	The skills learned in this CME course enhanced my professional competence. - 5	The skills learned in this CME course enhanced my professional competence. - 4	The skills learned in this CME course enhanced my professional competence. - 3	The skills learned in this CME course enhanced my professional competence. - 2	The skills learned in this CME course enhanced my professional competence. - 1	The skills learned in this CME course enhanced my professional competence. - NA
The skills learned in this CME course will be applied in the treatment of my patients.	The skills learned in this CME course will be applied in the treatment of my patients. - 5	The skills learned in this CME course will be applied in the treatment of my patients. - 4	The skills learned in this CME course will be applied in the treatment of my patients. - 3	The skills learned in this CME course will be applied in the treatment of my patients. - 2	The skills learned in this CME course will be applied in the treatment of my patients. - 1	The skills learned in this CME course will be applied in the treatment of my patients. - NA

As a result of attending this conference, to what extent do you agree that you will be better able to: (rate the objectives) *

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

	5	4	3	2	1	NA
Recognize signs and symptoms of physician burnout and effective means to promote physician well-being.	Recognize signs and symptoms of physician burnout and effective means to promote physician well-being. - 5	Recognize signs and symptoms of physician burnout and effective means to promote physician well-being. - 4	Recognize signs and symptoms of physician burnout and effective means to promote physician well-being. - 3	Recognize signs and symptoms of physician burnout and effective means to promote physician well-being. - 2	Recognize signs and symptoms of physician burnout and effective means to promote physician well-being. - 1	Recognize signs and symptoms of physician burnout and effective means to promote physician well-being. - NA
Identify and assess resident competencies and milestones as identified by the ACGME.	Identify and assess resident competencies and milestones as identified by the ACGME. - 5	Identify and assess resident competencies and milestones as identified by the ACGME. - 4	Identify and assess resident competencies and milestones as identified by the ACGME. - 3	Identify and assess resident competencies and milestones as identified by the ACGME. - 2	Identify and assess resident competencies and milestones as identified by the ACGME. - 1	Identify and assess resident competencies and milestones as identified by the ACGME. - NA
Provide feedback and mentorship to residents based on evaluations.	Provide feedback and mentorship to residents based on evaluations. - 5	Provide feedback and mentorship to residents based on evaluations. - 4	Provide feedback and mentorship to residents based on evaluations. - 3	Provide feedback and mentorship to residents based on evaluations. - 2	Provide feedback and mentorship to residents based on evaluations. - 1	Provide feedback and mentorship to residents based on evaluations. - NA
Identify and recognize health disparities in medicine.	Identify and recognize health disparities in medicine. - 5	Identify and recognize health disparities in medicine. - 4	Identify and recognize health disparities in medicine. - 3	Identify and recognize health disparities in medicine. - 2	Identify and recognize health disparities in medicine. - 1	Identify and recognize health disparities in medicine. - NA
Learn and demonstrate evidence-based teaching practices to promote excellence in clinical care.	Learn and demonstrate evidence-based teaching practices to promote excellence in clinical care. - 5	Learn and demonstrate evidence-based teaching practices to promote excellence in clinical care. - 4	Learn and demonstrate evidence-based teaching practices to promote excellence in clinical care. - 3	Learn and demonstrate evidence-based teaching practices to promote excellence in clinical care. - 2	Learn and demonstrate evidence-based teaching practices to promote excellence in clinical care. - 1	Learn and demonstrate evidence-based teaching practices to promote excellence in clinical care. - NA

How satisfied or dissatisfied were you with the following conference content? *

Scoring Key: 5=Strongly satisfied 4= Somewhat satisfied 3=Neither satisfied nor dissatisfied 2= Somewhat dissatisfied 1=Strongly dissatisfied

	5	4	3	2	1
Lecture materials.	Lecture materials. - 5	Lecture materials. - 4	Lecture materials. - 3	Lecture materials. - 2	Lecture materials. - 1
Speaker's effectiveness in addressing the learning objectives	Speaker's effectiveness in addressing the learning objectives - 5	Speaker's effectiveness in addressing the learning objectives - 4	Speaker's effectiveness in addressing the learning objectives - 3	Speaker's effectiveness in addressing the learning objectives - 2	Speaker's effectiveness in addressing the learning objectives - 1

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

Yes

No

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

What, if any, new skills/strategies will you apply in your clinical practice?

If you do not plan to implement any new skills/strategies in your clinical practice, what is keeping you from doing so?

Please provide any additional comments or suggestions.

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Family Medicine Residency Faculty Development Evaluation