Heat Stress and Heat Illness Prevention: Climate Change, Heat, and Making Your Practice Environmentally Sustainable 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

How confident are you in your ability to: *

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
Discuss climate factors which are contributing to increased days of extreme heat.	Discuss climate factors which are contributing to increased days of extreme heat. - 5	Discuss climate factors which are contributing to increased days of extreme heat. - 4	Discuss climate factors which are contributing to increased days of extreme heat. - 3	Discuss climate factors which are contributing to increased days of extreme heat. - 2	Discuss climate factors which are contributing to increased days of extreme heat. - 1
Recognize signs and symptoms of heat illness.	Recognize signs and symptoms of heat illness. - 5	Recognize signs and symptoms of heat illness. - 4	Recognize signs and symptoms of heat illness. - 3	Recognize signs and symptoms of heat illness. - 2	Recognize signs and symptoms of heat illness. - 1
Implement environmentally sustainable habits into routine clinical practice.	Implement environmentally sustainable habits into routine clinical practice. - 5	Implement environmentally sustainable habits into routine clinical practice. - 4	Implement environmentally sustainable habits into routine clinical practice. - 3	Implement environmentally sustainable habits into routine clinical practice. - 2	Implement environmentally sustainable habits into routine clinical practice. - 1
Integrate education on climate health impacts into routine patient encounters.	Integrate education on climate health impacts into routine patient encounters. - 5	Integrate education on climate health impacts into routine patient encounters. - 4	Integrate education on climate health impacts into routine patient encounters. - 3	Integrate education on climate health impacts into routine patient encounters. - 2	Integrate education on climate health impacts into routine patient encounters. - 1
Recommend local resources to patients to reduce their risk of heat illness.	Recommend local resources to patients to reduce their risk of heat illness. - 5	Recommend local resources to patients to reduce their risk of heat illness. - 4	Recommend local resources to patients to reduce their risk of heat illness. - 3	Recommend local resources to patients to reduce their risk of heat illness. - 2	Recommend local resources to patients to reduce their risk of heat illness. - 1

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
Describe patient characteristics associated with increased risk for heat illness.	Describe patient characteristics associated with increased risk for heat illness. - 5	Describe patient characteristics associated with increased risk for heat illness. - 4	Describe patient characteristics associated with increased risk for heat illness. - 3	Describe patient characteristics associated with increased risk for heat illness. - 2	Describe patient characteristics associated with increased risk for heat illness. - 1	Describe patient characteristics associated with increased risk for heat illness. - NA
Determine appropriate interventions for the treatment of heat illness in the adult and pediatric populations.	Determine appropriate interventions for the treatment of heat illness in the adult and pediatric populations. - 5	Determine appropriate interventions for the treatment of heat illness in the adult and pediatric populations. - 4	Determine appropriate interventions for the treatment of heat illness in the adult and pediatric populations. - 3	Determine appropriate interventions for the treatment of heat illness in the adult and pediatric populations. - 2	Determine appropriate interventions for the treatment of heat illness in the adult and pediatric populations. - 1	Determine appropriate interventions for the treatment of heat illness in the adult and pediatric populations. - NA
Integrate education on climate health impacts into routine patient encounters.	Integrate education on climate health impacts into routine patient encounters. - 5	Integrate education on climate health impacts into routine patient encounters. - 4	Integrate education on climate health impacts into routine patient encounters. - 3	Integrate education on climate health impacts into routine patient encounters. - 2	Integrate education on climate health impacts into routine patient encounters. - 1	Integrate education on climate health impacts into routine patient encounters. - 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

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

Screening patients for risk factors for heat stress/heat illness

Making resources available to patients/families on energy assistance

Use alternative communication methodologies with patients / families to educate on heat illness prevention

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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Heat Stress and Heat Illness Prevention: Climate Change, Heat, and Making Your Practice Environmentally Sustainable Evaluation