Mental Health Conference Series: Professional Health Programs: A Model for Success 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= Somewhat agree 3=Neither agree nor disagree 2= Somewhat disagree 1=Strongly disagree

	5	4	3	2	1
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 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

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= Somewhat agree 3=Neither agree nor disagree 2= Somewhat disagree 1=Strongly disagree NA=Not applicable

	5	4	3	2	1	N/A
Recognize potentially impairing conditions (performance concerns) in healthcare professionals.	Recognize potentially impairing conditions (performance concerns) in healthcare professionals. - 5	Recognize potentially impairing conditions (performance concerns) in healthcare professionals. - 4	Recognize potentially impairing conditions (performance concerns) in healthcare professionals. - 3	Recognize potentially impairing conditions (performance concerns) in healthcare professionals. - 2	Recognize potentially impairing conditions (performance concerns) in healthcare professionals. - 1	Recognize potentially impairing conditions (performance concerns) in healthcare professionals. - N/A
Describe professional healthcare programs (PHPs) evaluation, follow-up process and outcomes.	Describe professional healthcare programs (PHPs) evaluation, follow-up process and outcomes. - 5	Describe professional healthcare programs (PHPs) evaluation, follow-up process and outcomes. - 4	Describe professional healthcare programs (PHPs) evaluation, follow-up process and outcomes. - 3	Describe professional healthcare programs (PHPs) evaluation, follow-up process and outcomes. - 2	Describe professional healthcare programs (PHPs) evaluation, follow-up process and outcomes. - 1	Describe professional healthcare programs (PHPs) evaluation, follow-up process and outcomes. - N/A
Access Professionals Resource Network (PRN) services, explain what conditions may be monitored by and the process of referrals.	Access Professionals Resource Network (PRN) services, explain what conditions may be monitored by and the process of referrals. - 5	Access Professionals Resource Network (PRN) services, explain what conditions may be monitored by and the process of referrals. - 4	Access Professionals Resource Network (PRN) services, explain what conditions may be monitored by and the process of referrals. - 3	Access Professionals Resource Network (PRN) services, explain what conditions may be monitored by and the process of referrals. - 2	Access Professionals Resource Network (PRN) services, explain what conditions may be monitored by and the process of referrals. - 1	Access Professionals Resource Network (PRN) services, explain what conditions may be monitored by and the process of referrals. - N/A

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

Rate the following *

Scoring Key: 5=Great Deal 4= A Good Bit 3=Some 2=Little 1=Very Little

	5	4	3	2	1
How much did you learn as a result of this CE program?	How much did you learn as a result of this CE program? - 5	How much did you learn as a result of this CE program? - 4	How much did you learn as a result of this CE program? - 3	How much did you learn as a result of this CE program? - 2	How much did you learn as a result of this CE program? - 1

Rate the following *

Scoring Key: 5=Extremely useful 4= A Good Deal Useful 3=Somewhat Useful 2=A Little Useful 1=Not Useful

	5	4	3	2	1
How useful was the content of this CE program for your practice or other professional development?	How useful was the content of this CE program for your practice or other professional development? - 5	How useful was the content of this CE program for your practice or other professional development? - 4	How useful was the content of this CE program for your practice or other professional development? - 3	How useful was the content of this CE program for your practice or other professional development? - 2	How useful was the content of this CE program for your practice or other professional development? - 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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Mental Health Conference Series: Professional Health Programs: A Model for Success Evaluation