MCI Hematology Case Review Evaluation Form

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 course, 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
Analyze risk stratifications in patients with hematologic malignancies at diagnosis or disease recurrence.	Analyze risk stratifications in patients with hematologic malignancies at diagnosis or disease recurrence. - 5	Analyze risk stratifications in patients with hematologic malignancies at diagnosis or disease recurrence. - 4	Analyze risk stratifications in patients with hematologic malignancies at diagnosis or disease recurrence. - 3	Analyze risk stratifications in patients with hematologic malignancies at diagnosis or disease recurrence. - 2	Analyze risk stratifications in patients with hematologic malignancies at diagnosis or disease recurrence. - 1	Analyze risk stratifications in patients with hematologic malignancies at diagnosis or disease recurrence. - 0
Develop comprehensive care in complex clinical management of patients with hematologic malignancies.	Develop comprehensive care in complex clinical management of patients with hematologic malignancies. - 5	Develop comprehensive care in complex clinical management of patients with hematologic malignancies. - 4	Develop comprehensive care in complex clinical management of patients with hematologic malignancies. - 3	Develop comprehensive care in complex clinical management of patients with hematologic malignancies. - 2	Develop comprehensive care in complex clinical management of patients with hematologic malignancies. - 1	Develop comprehensive care in complex clinical management of patients with hematologic malignancies. - 0
Discuss clinical decisions and optimize timely referral of patients for potential stem cell transplants.	Discuss clinical decisions and optimize timely referral of patients for potential stem cell transplants. - 5	Discuss clinical decisions and optimize timely referral of patients for potential stem cell transplants. - 4	Discuss clinical decisions and optimize timely referral of patients for potential stem cell transplants. - 3	Discuss clinical decisions and optimize timely referral of patients for potential stem cell transplants. - 2	Discuss clinical decisions and optimize timely referral of patients for potential stem cell transplants. - 1	Discuss clinical decisions and optimize timely referral of patients for potential stem cell transplants. - 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

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

Yes

No

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

Please list specific changes you intend to implement in your daily practice as a result of attending this activity. *

What are the potential barriers or obstacles that might prevent you from implementing new strategies you learned at this conference? *

Comments

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MCI Hematology Case Review Evaluation Form