Promoting Physician Well-Being Evaluation - June 24, 2021

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 NA=Not applicable

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

	5	4	3	2	1	NA
Recognize the importance of well-being for physicians and residents.	Recognize the importance of well-being for physicians and residents. - 5	Recognize the importance of well-being for physicians and residents. - 4	Recognize the importance of well-being for physicians and residents. - 3	Recognize the importance of well-being for physicians and residents. - 2	Recognize the importance of well-being for physicians and residents. - 1	Recognize the importance of well-being for physicians and residents. - NA
Discuss the ACGME Common Program Requirements for Residency Education (formally known as Duty Hour regulations).	Discuss the ACGME Common Program Requirements for Residency Education (formally known as Duty Hour regulations). - 5	Discuss the ACGME Common Program Requirements for Residency Education (formally known as Duty Hour regulations). - 4	Discuss the ACGME Common Program Requirements for Residency Education (formally known as Duty Hour regulations). - 3	Discuss the ACGME Common Program Requirements for Residency Education (formally known as Duty Hour regulations). - 2	Discuss the ACGME Common Program Requirements for Residency Education (formally known as Duty Hour regulations). - 1	Discuss the ACGME Common Program Requirements for Residency Education (formally known as Duty Hour regulations). - NA
Recognize the signs of fatigue/sleep deprivation, burnout, depression, and substance abuse.	Recognize the signs of fatigue/sleep deprivation, burnout, depression, and substance abuse. - 5	Recognize the signs of fatigue/sleep deprivation, burnout, depression, and substance abuse. - 4	Recognize the signs of fatigue/sleep deprivation, burnout, depression, and substance abuse. - 3	Recognize the signs of fatigue/sleep deprivation, burnout, depression, and substance abuse. - 2	Recognize the signs of fatigue/sleep deprivation, burnout, depression, and substance abuse. - 1	Recognize the signs of fatigue/sleep deprivation, burnout, depression, and substance abuse. - NA
Evaluate the effect of fatigue/sleep deprivation, burnout, depression, and substance abuse on physician’s functioning and performance.	Evaluate the effect of fatigue/sleep deprivation, burnout, depression, and substance abuse on physician’s functioning and performance. - 5	Evaluate the effect of fatigue/sleep deprivation, burnout, depression, and substance abuse on physician’s functioning and performance. - 4	Evaluate the effect of fatigue/sleep deprivation, burnout, depression, and substance abuse on physician’s functioning and performance. - 3	Evaluate the effect of fatigue/sleep deprivation, burnout, depression, and substance abuse on physician’s functioning and performance. - 2	Evaluate the effect of fatigue/sleep deprivation, burnout, depression, and substance abuse on physician’s functioning and performance. - 1	Evaluate the effect of fatigue/sleep deprivation, burnout, depression, and substance abuse on physician’s functioning and performance. - 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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Promoting Physician Well-Being Evaluation - June 24, 2021