The Health Impacts of Climate Change Series: Planetary Health: A Framework for Sustainable Health Systems to Mitigate the Effects of Climate Change

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, how confident are you in your ability to implement these strategies (rate the objectives): *

5 = High level of confidence 4 = Moderately high level of confidence 3 = Average level of confidence 2 = Low level of confidence 1 = No level of confidence

	5	4	3	2	1
Review the role of greenhouse gases in relation to climate change.	Review the role of greenhouse gases in relation to climate change. - 5	Review the role of greenhouse gases in relation to climate change. - 4	Review the role of greenhouse gases in relation to climate change. - 3	Review the role of greenhouse gases in relation to climate change. - 2	Review the role of greenhouse gases in relation to climate change. - 1
Understand how the healthcare sector contributes to greenhouse gas emissions.	Understand how the healthcare sector contributes to greenhouse gas emissions. - 5	Understand how the healthcare sector contributes to greenhouse gas emissions. - 4	Understand how the healthcare sector contributes to greenhouse gas emissions. - 3	Understand how the healthcare sector contributes to greenhouse gas emissions. - 2	Understand how the healthcare sector contributes to greenhouse gas emissions. - 1
Illustrate the negative effects that plastic waste and anesthetic gases have on the environment.	Illustrate the negative effects that plastic waste and anesthetic gases have on the environment. - 5	Illustrate the negative effects that plastic waste and anesthetic gases have on the environment. - 4	Illustrate the negative effects that plastic waste and anesthetic gases have on the environment. - 3	Illustrate the negative effects that plastic waste and anesthetic gases have on the environment. - 2	Illustrate the negative effects that plastic waste and anesthetic gases have on the environment. - 1
Analyze current practices that minimize anesthetic waste and their efficacy.	Analyze current practices that minimize anesthetic waste and their efficacy. - 5	Analyze current practices that minimize anesthetic waste and their efficacy. - 4	Analyze current practices that minimize anesthetic waste and their efficacy. - 3	Analyze current practices that minimize anesthetic waste and their efficacy. - 2	Analyze current practices that minimize anesthetic waste and their efficacy. - 1
Implement healthcare sustainability strategies to reduce greenhouse gases.	Implement healthcare sustainability strategies to reduce greenhouse gases. - 5	Implement healthcare sustainability strategies to reduce greenhouse gases. - 4	Implement healthcare sustainability strategies to reduce greenhouse gases. - 3	Implement healthcare sustainability strategies to reduce greenhouse gases. - 2	Implement healthcare sustainability strategies to reduce greenhouse gases. - 1

How many patients in a month do you see displaying health effects of climate change ? Other...

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 do you intend to do differently in the treatment of your patients as a result of what you learned at this conference? What new strategies will you apply in your practice of patient care? (select all that apply) *

Using billing codes related to heat stress / heat illness/air pollution.

Screening patients for risk factors for heat stress/heat illness/pollution exposure.

Making resources available to patients/families on energy assistance.

Use alternative communication methodologies with patients / families to educate on health impacts of climate change.

None;

None; I am not currently in 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.

Name

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The Health Impacts of Climate Change Series: Planetary Health: A Framework for Sustainable Health Systems to Mitigate the Effects of Climate Change